Wisconsin Medicaid Now Covers Ketamine Therapy for Depression
Starting January 1st, Wisconsin Medicaid will cover IV ketamine therapy for major depressive disorder (MDD), including cases with suicidality. This groundbreaking decision places Wisconsin among the first states to provide this cutting-edge treatment through a Medicaid system. With an approved prior authorization, patients struggling with severe depression will have access to a therapy that has shown remarkable promise in reducing symptoms and offering hope where other treatments have failed.
The coverage policy, outlined in a detailed ForwardHealth document, includes essential clinical guidelines and billing codes to streamline implementation. This move is a major win for interventional psychiatry and a step toward making innovative treatments more accessible.
Looking for treatment? Find ketamine clinics closest to you as well as other psychedelic therapies in your area.
Who Qualifies for Ketamine Therapy Under Medicaid?
For individuals with MDD and active suicidality, the clinical criteria for coverage include:
- Being an adult (18 or older) with a confirmed MDD diagnosis.
- No active substance use disorder.
- Active suicidal thoughts requiring symptom control.
- Use of IV ketamine alongside an oral antidepressant.
Patients with MDD but without suicidality must meet slightly different criteria. They must demonstrate treatment resistance, defined as lack of response to at least two prior trials of antidepressants, such as SSRIs, SNRIs, or bupropion. These carefully designed requirements aim to ensure ketamine therapy is used effectively and appropriately.
New: Interested in Being Part of a Psychedelics-Focused Clinical Trial? Sign Up Here
What Does Coverage Look Like?
Initial approvals will cover three months of treatment, allowing for a maximum of eight infusions. Renewals extend to six months, offering up to 13 additional infusions. This structured approach balances accessibility with careful oversight.
Affordable Innovation
This policy also provides a more affordable alternative to Johnson & Johnson’s esketamine nasal spray (Spravato), widening access to those who may not have been able to afford innovative depression treatments. It signals a future where advanced care options are not only groundbreaking but also equitable.
This expansion of Medicaid coverage is a powerful signal that mental health is being prioritized. Could this set the stage for broader adoption of interventional psychiatry across the nation?
