Why Doesn’t Colorado Medicaid Cover TMS—and Why That Needs to Change

What Is TMS and Why Is It So Effective for Depression?

Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-approved treatment for major depressive disorder. It works by delivering short magnetic pulses to stimulate areas of the brain associated with mood regulation. Unlike traditional antidepressants, TMS targets the brain directly and comes without the systemic side effects of medication.

A landmark study by Stanford University showed a 70-80% success rate for patients receiving TMS treatment. Patients not only experienced symptom relief, but also a meaningful improvement in overall well-being. It’s a breakthrough therapy for individuals with treatment-resistant depression who have not responded to at least two medications.

Why Doesn’t Colorado Medicaid Cover TMS for Depression?

Despite TMS being covered by every major commercial insurer, Colorado’s Medicaid program does not offer coverage. This puts Colorado behind 16 other states that recognize TMS as a valid, effective, and economical treatment for depression.

The lack of coverage prevents low-income Coloradans from accessing a life-changing therapy. As a result, Medicaid patients often remain stuck in cycles of ineffective medication trials, hospitalizations, or emergency room visits.

States That Cover TMS with Medicaid—And Where Colorado Falls Short

Currently, 16 states offer Medicaid coverage for TMS: Arizona, Connecticut, Indiana, Iowa, Minnesota, Missouri, Montana, Nevada, New Jersey, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, and Washington. Most require patients to try and fail two medications before becoming eligible for TMS coverage.

Colorado’s omission is concerning, especially when considering that Medicaid is the largest payer for mental health services nationwide.

The Real Cost of Ignoring Depression in Colorado

Between 2016 and 2018, more than 17,000 Coloradans visited emergency rooms for mental health crises, costing over $76 million. Two-thirds of those visits were by Medicaid-insured patients. Treating mental illness reactively rather than proactively not only burdens emergency services but also drains public funds.

Moreover, research shows that a 1-point reduction in a patient's PHQ-9 depression score leads to a 1.65% increase in productivity. In economic terms, investing in TMS means more people can return to work and contribute to the community.

Why TMS Is Especially Important for Medicaid Patients and Communities of Color

TMS is a medication-free treatment—a vital point for communities who experience adverse side effects from medication or distrust medical institutions. Among Coloradans, nearly half cited stigma as a barrier to seeking mental health care. Historical abuses, such as the Tuskegee experiment and forced sterilizations, have left deep-rooted mistrust among minority groups.

Offering a non-drug-based, outpatient treatment like TMS promotes equity and begins to address systemic disparities in mental health care.

How Axis Is Bridging the Gap for Medicaid Patients

At Axis Integrated Mental Health, we believe in access to evidence-based care for everyone, regardless of insurance status. That's why we've committed $100,000 to covering TMS treatment for Medicaid patients in Colorado. Today, Axis is the only clinic in the state providing TMS to Medicaid-insured patients.

Our goal is not only to treat patients, but to lead by example. We hope that other clinics and providers will follow suit and advocate for more inclusive care.

What Needs to Change: Advocating for TMS Coverage in Colorado

Colorado ranks 45th in the nation for adult mental health and access to care. We can change that by advocating for Medicaid coverage of TMS. Write to Governor Jared Polis. Share this blog on social media. Speak up at local health policy meetings.

Together, we can push for a future where everyone, regardless of income, has access to effective, medication-free mental health treatment.

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