Oregon Health Plan (Medicaid): What Are Your Potential Treatment Options?

Medicaid, along with Medicare, was signed into federal law in 1965 to make health insurance available to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered at the state level, and each state has a program office, sometimes with a unique name. For example, “Medicaid Oregon” operates under the official name of the “Oregon Health Plan.” Many who are insured through the state may wonder, “What does Oregon Health Plan cover? ” Those who are covered by the Oregon Health Plan and seeking treatment for depression can rest assured that a variety of providers and treatment options are covered. Through the Oregon Health Plan, psychiatrists and other mental health professionals can be found, and treatments are often quite affordable for the patient. One treatment that has helped many patients achieve remission from depression, but without coverage can be prohibitively expensive, is transcranial magnetic stimulation (TMS). Transcranial magnetic stimulation insurance coverage is a reality; many private insurers will cover the TMS therapy cost if specific criteria are met. The Oregon Health Plan, in particular, will usually cover the TMS treatment cost if a patient has undergone two or more failed trials of antidepressant medications. Currently, Active Recovery TMS is the only provider of transcranial magnetic stimulation that works with Medicaid in Oregon to get patients the TMS treatment they need.

 How to Find a Mental Health Care Provider and Get Treatment

 If you suspect that you are experiencing signs and symptoms of depression, it is critical to find a mental health practitioner and seek treatment. Many different roles fall under the umbrella of “mental health care provider,” but most patients will initially seek depression treatment from their primary care physician, or from a specialized mental health professional, such as a psychiatrist or a psychiatric-mental health nurse practitioner (PMHNP).

Those who are covered by Medicaid in Oregon can easily find an answer to their usual first question: “What does Oregon Health Plan cover?” The real question, however, is how to find the perfect practitioner who accepts Medicaid, and this process is usually a little more involved than simply entering “Oregon Health Plan psychiatrist” into Google.

 

 

The first step in getting depression treatment through the Oregon Health Plan is to identify your coordinated care organization (CCO). Your CCO is a network of various providers (physical health care, addictions and mental health care, and dental care providers), who work together in their local communities to serve people who receive health care coverage through the Oregon Health Plan (Medicaid). If you are covered by the Oregon Health Plan but do not know which CCO you belong to, view the map below or click here.

 

Once you have identified the CCO you belong to, you can contact them to get a list of mental health providers. Working from this list, you’ll be able to use sites like Healthgrades to obtain comprehensive information about each practitioner’s professional background and practice scope, along with reviews of the care other patients have received. Once you have decided on a provider, make an appointment to receive a diagnosis and begin an initial treatment plan.

 Antidepressant Drugs Are a Common Initial Treatment for Depression

 Whether you are covered by a private insurer or the Oregon Health Plan, psychiatrists and PMHNPs are likely to prescribe an antidepressant medication regimen, either alone or in conjunction with therapy. Talk therapy is extremely important because it can help those suffering from depression gain new perspective on their lives and develop coping skills, both of which can have a positive impact on the way the patient approaches life’s challenges. Talk therapy alone, however, is not as effective in treating the full spectrum of depressive symptoms as it is when paired with a medication regimen.

The most commonly prescribed antidepressant drugs, in order of decreasing commonality, are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, atypical antipsychotics, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). A large part of the reason why some antidepressant medications are prescribed more commonly than others is the severity of the side effects. The more common SSRI group (Zoloft, Prozac, Celexa) have less intense side effects than older antidepressant classes like TCAs and MAOIs. Many depression patients receive their first prescription for SSRIs from a primary care physician; rarely will a provider who doesn’t specialize in mental health prescribe an MAOI. These more intense drug classes tend to be introduced in the event that first-line antidepressants are unsuccessful, or if the case of depression in question is clearly and demonstrably severe.

 TMS Can Be the Most Appropriate Option if First-Line Options Fail

 In some cases, depression symptoms do not improve with antidepressant drug treatment. Generally, a lack of response to antidepressant drugs can be the result of any of the following factors: insufficient treatment, failure to follow the treatment plan, comorbid psychiatric or medical disorders, or the failure of the treatment method itself. If a case of depression persists through multiple rounds of antidepressant drug treatment, transcranial magnetic stimulation (TMS) may be an effective (and covered) solution.

Treatment-resistant depression is functionally defined as a case of major depressive disorder (MDD) that does not improve sufficiently or meaningfully in response to at least two antidepressant trials. TMS is the ideal option for patients whose depression has treatment-resistant features. It has fewer and less intense side effects than second-line antidepressant drug treatments (MAOIs, antipsychotics, TCAs, lithium). It is also a less intensive treatment, with longer durability of benefits, than another somatic therapy familiar to many in psychiatry and notorious in popular culture: electroconvulsive therapy (ECT). ECT is still a last-line treatment used in cases of severe depression, but TMS may be a more appropriate option for those whose depression does not have psychotic features or require immediate hospitalization.

Transcranial magnetic stimulation insurance coverage exists for the privately insured already. Coverage is important to determine in advance because, like most medical procedures, the TMS treatment cost can be high for many patients to cover out-of-pocket — a single session can cost $400-$500. The cumulative TMS therapy cost can amount to around $15,000. In the case of the Oregon Health Plan, transcranial magnetic stimulation insurance coverage is not available to those insured by the state unless two different antidepressant treatment plans have failed. At the time of this writing, Active Recovery TMS is the only TMS provider in Oregon that works with the Oregon Health Plan as a way to cover the TMS therapy cost.

TMS Therapy Is Available to Those Insured by the Oregon Health Plan

For those suffering from cases of severe or treatment-resistant depression, the road to remission can be long and arduous. It is important to remember that, under the Oregon Health Plan, the pathway to treatment is clear: find a provider, obtain a diagnosis, and follow the prescribed treatment plan. If first-line treatments prove unsuccessful, TMS may be an appropriate and effective treatment for your case. If this sounds like your situation, contact Active Recovery TMS today.


FAQ’s

What do I do if I can’t cope?

If you feel like you’re not coping seek out some professional help. Often the first place to start is to see your doctor who, even if they can’t help directly, will be able to offer advice on who to see and how to proceed.

What are the main treatments for depression?

Depression can be treated with lifestyle changes, talk therapy, antidepressants, ECT, and TMS.

What is TMS?

TMS stands for transcranial magnetic stimulation. It’s a treatment that uses magnets to stimulate the prefrontal cortex to promote brain cell activity to decrease depressive symptoms. It’s a drug free therapy with contraindications so limited that patients require no post-treatment monitoring and are able to drive home straight away.

What are the most common side effects of TMS?

The most common side effects of TMS are scalp discomfort and headache.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Recovery TMS website is solely at your own risk.

Meet Jonathan Horey, MD

Dr. Jonathan Horey became familiar with TMS while training and working at Columbia University in New York City where many of the early and important studies on TMS were conducted. Dr. Horey has since completed more extensive training in TMS and keeps himself up-to-date with the latest research on brain stimulation techniques, including TMS.