Alexis Irazoque, M.S., CCC-SLP
At Expressable, we often hear from families who are trying to start speech therapy and doing everything right. They’ve confirmed their child has Medicaid, but then they learn their specific MCO plan isn’t accepted for speech therapy. It’s frustrating and confusing, and it can feel like you’re hitting a wall just trying to get your child the help they need.
So what’s going on?
In this article, we explain what an MCO (managed care organization) is in health insurance, how it applies to Medicaid, and why not all plans are accepted by a speech therapy provider. Whether you’re asking, “What is an MCO for Medicaid?” or wondering why your insurance doesn’t cover speech therapy, we’re here to break it down in simple terms.
You deserve answers. Let’s walk through what MCOs mean for your child’s speech therapy coverage and what steps you can take to find speech therapy that’s covered.
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We know insurance can be tricky. We'll help you understand your benefits and whether speech therapy is covered.
Get startedWhat is a managed care organization (MCO)?
A managed care organization (MCO) is a type of health insurance company that helps manage how care is provided. Their main goal is to lower health care costs without lowering the quality of care. They do this by working with doctors, therapists, hospitals, and other health care providers in a network. When you use providers in that network, your costs are usually lower.
You might already be familiar with common types of managed care plans like health maintenance organizations, or HMOs. These plans usually require you to pick a primary care doctor who helps coordinate your care. They also limit you to seeing providers within a certain network. That’s one way MCOs help keep costs more predictable for families.
Both Medicaid and some commercial health plans (like UnitedHealthcare, or UHC) use MCOs to offer services. Each state in the U.S. often has several different MCOs to choose from. And while they may all work with Medicaid, each MCO has its own network and rules. That’s why one Medicaid or UHC plan may be accepted by a doctor or other provider, while another is not.
Basically, MCOs help organize services so families can get the care they need. But MCO plans come with a few extra rules.
What’s the difference between Medicaid and an MCO?
Medicaid is a public health insurance program provided by the government. It helps people who meet certain requirements, like having a low income or a disability, get the medical care they need.
Here’s where it gets tricky: In many states, Medicaid partners with private managed care organizations to actually deliver those services. MCOs help organize and manage health care for families on Medicaid.
So, if your child has Medicaid, they may also be enrolled in a specific MCO, like Sunshine Health, Aetna Better Health, or Humana Healthy Horizons. That MCO is who manages your child’s care day-to-day.
Think of it like this:
Medicaid is the health care program.
The MCO is the company that helps provide the care.
This means that not every Medicaid provider will accept every MCO. Even if a speech therapist accepts Medicaid, they may not be in-network with your specific MCO. That’s why you might hear, “We accept Medicaid, but not that plan.”
How MCOs work within bigger health insurance plans
Here’s something that surprises many families: Big insurance companies, like UnitedHealthcare (UHC), Aetna, or even Medicaid, don’t just have one health plan. They offer many different plans under their name, and some of those are managed by MCOs.
Think of it like going to a popular restaurant chain. Even though the name on the sign is the same, each location might have a slightly different menu or accept different coupons. The same idea applies to insurance. Just because your doctor or speech therapist says they accept UHC, it doesn’t always mean they’re in-network with every single UHC plan or MCO.
If a speech therapist accepts Medicaid but isn’t in your MCO’s network, your plan may not cover that therapist’s services.
That’s because MCOs often create their own provider networks. A provider network is a list of doctors, therapists, and specialists that MCOs partner with in specific areas. Providers in these networks agree to offer services at reduced costs. But if a speech therapist isn’t in your specific MCO’s network, your plan may not cover that therapist’s services, or it may only pay for part of them.
So even if your health insurance card says “UnitedHealthcare,” your exact plan matters. That’s why one family with UHC might be covered and another might not. It all depends on which MCO or sub-plan you’re enrolled in.
Why do speech therapy providers only accept certain MCO plans?
It can feel frustrating when you find a great speech therapist, only to learn they don’t accept your insurance plan. You’re not alone, and this isn’t about turning families away. It’s about making sure providers can offer the best care possible in a way that’s sustainable.
Here’s why this happens:
Speech therapy providers must apply and be approved by each individual MCO they want to work with. This is called the credentialing and contracting process, and it takes time, paperwork, and agreement on how the provider will be paid.
Not every MCO contracts with every provider, and not every provider chooses to contract with every MCO.
Not every MCO contracts with every health care provider, and not every provider chooses to contract with every MCO. There are a few big reasons why:
Reimbursement rates vary. Some MCOs pay less for speech therapy services, which may not cover the speech therapy provider’s costs.
Provider capacity. A speech therapy clinic might only have room for a certain number of clients, so they can’t accept every plan.
Administrative load. Each MCO has its own rules, paperwork, and approval steps. Providers may stick to the plans that are simpler or more efficient to manage.
It’s important to know that this isn’t about denying care. It’s about making sure speech therapists can focus on providing high-quality therapy instead of dealing with paperwork and billing problems.
If your plan isn’t accepted, it’s not a reflection of you or your child. It’s simply part of how insurance and health care work behind the scenes. The good news? There are often other options to explore.
How to find out if your insurance covers speech therapy
If you’re not sure if your insurance will cover or deny a certain speech therapy provider, you’re not alone. We’re here to help you make sense of it all.
Insurance can be confusing, especially when managed care organizations are involved. But asking the right questions can make a big difference. Here are five simple questions you can ask your insurance company or MCO representative to get clear answers:
1 Is my plan a managed care organization (MCO)?
If so, which one? Plans like Medicaid or UnitedHealthcare often have multiple sub-plans under different MCOs.
2 Does my MCO plan include coverage for speech therapy?
Coverage can vary between plans, even under the same insurance company.
3 Is my speech therapy provider (like Expressable) in-network with this plan?
Be sure to provide the full name of your plan and MCO when asking.
4 Are there any prior authorization requirements or session limits I should know about?
Some plans limit the number of therapy sessions per year or require approval before starting therapy.
5 Are teletherapy services covered under this plan?
This is especially important if you prefer online speech therapy for convenience or access.
Once you have this information, follow these steps:
Share it with the speech therapy provider so they can confirm their network status and help you plan next steps.
If the speech therapy provider isn’t in-network, ask your insurance company to help you find someone who is.
Explore whether you have out-of-network benefits or private pay options. Some families choose these routes based on their situation.
We know this process can be frustrating. If you have questions, feel free to contact Expressable for help. We’re happy to help you find the best path forward for your child’s care.
Talk with a specialist at Expressable for free
Get started by talking with a specialist at Expressable. Ask questions, share your concerns, and learn more about how insurance for speech therapy works. Click here to schedule your free consultation phone call. It's quick, simple, and there’s no obligation to sign up for speech therapy. We’re here to help!
