Medicaid goes by a different name in almost every Midwest state. In Missouri it is MO HealthNet. In Kansas it is KanCare, in Oklahoma SoonerCare, in Wisconsin BadgerCare Plus. But the question facing a member with stubborn depression is the same everywhere: if a treatment exists that I have never heard of, which door do I knock on to find out whether it is for me?
This piece compares the three main doors, with numbers from our publisher's commissioned survey of 443 adults across the region, and adds practical notes for Medicaid members wherever they live in the region.
The treatment behind the doors
The treatment in question is esketamine, a nasal spray sold as Spravato. Two adult uses carry FDA approval: depression that has resisted treatment, usually after at least two antidepressants, and major depression marked by acute suicidal thoughts or behavior. Administration happens only at certified treatment centers; each dose is followed by at least two hours of observation, and driving waits until after a night's sleep.
Across our sample, it is close to invisible. Of our respondents, 73 percent had no familiarity with the name Spravato. Twenty-one percent more knew the name only. That leaves 6 percent who could say what it is. Every figure is final and validated; one is broken out for Medicaid, none by state.
When most people do not know the name, the door you choose matters, because the person behind it is the one who will bring the treatment up or leave it unmentioned. A plain explainer on Spravato can help you name it yourself.
Door one: your primary care provider
How many people would choose it: Primary care was the clear favorite. Fifty-six percent of respondents said it would be their first stop; of the 163 respondents on Medicaid, 61 percent picked this door.
Strengths for a Medicaid member: Nearly every Medicaid managed care plan in the region assigns or asks you to choose a primary care provider, so you likely already have one. Visits usually cost little or nothing. Your primary care provider can screen for depression, check for medical causes, review your medication history, and make any referral your plan requires.
Limits: Primary care practices vary widely in how familiar they are with esketamine. Some may not have referred anyone for it. Appointments are short. You may need to raise the topic yourself.
Best for: Almost everyone as a starting point, and especially anyone whose plan requires a referral for specialty mental health care.
Door two: a psychiatrist or mental health provider
How many people would choose it: Twenty-three percent of respondents, just under a quarter, would go here first.
Strengths: Psychiatrists and psychiatric nurse practitioners manage treatment-resistant depression routinely. They are more likely to know which certified centers exist nearby and how prior authorization tends to work. Some community mental health centers across the Midwest serve Medicaid members and have psychiatric prescribers on staff.
Limits: Wait times for psychiatry can be long, especially outside major metro areas. Some plans require a referral first. Not every psychiatrist accepts Medicaid, so confirm with your plan before booking.
Best for: People who already have a psychiatric prescriber, or whose primary care provider suggests a specialist evaluation.
Door three: searching on your own
How many people would choose it: Twelve percent said they would begin by researching online. Another 5 percent had no sense of where to begin.
Strengths: You can learn the vocabulary, find the manufacturer's treatment center locator, and read about what sessions involve.
Limits: Searching alone cannot get you a prescription, and results skew toward advertising. The search phrases respondents offered included "depression medicine alternatives" and "therapist near me." Searches like those often lead to cash-pay ketamine clinics or online at-home ketamine companies, which are different from esketamine, generally off-label, and usually not billed to Medicaid.
Best for: Preparation, not as a substitute for a clinician.
What the survey says about which door carries weight
One finding tilts the comparison. Respondents' own doctors were the most persuasive voice, picked 74 percent of the time. A friend or family member drew 18 percent. Advertising drew 2 percent.
Notes that apply in every Midwest Medicaid program
- Find your plan's member line. Whether you are on IA Health Link in Iowa, Heritage Health in Nebraska, HealthChoice Illinois, or Medicaid in Indiana, Ohio, or Minnesota, the plan's member services number is the fastest route to answers about covered drugs and in-network centers.
- Ask about prior authorization. Newer medications are commonly covered only after the plan reviews paperwork from your prescriber. Documented history of prior antidepressants is usually central.
- Ask about rides. Medicaid programs generally include non-emergency medical transportation. Since driving after an esketamine session is off limits, ask whether rides can cover a multi-hour visit.
- Watch your renewal. Every state requires periodic Medicaid renewals. A lapse mid-treatment is a painful setback.
Coverage as the common thread
Medicaid was one of the two most frequently reported types of coverage in our sample, at 37 percent, nearly tied with commercial insurance at 39 percent. And coverage was the priority people named most: 85 percent put it among the top two factors in choosing a provider. Asked to trade coverage with extra steps against paying for a quicker start, just over half preferred the covered route with its hoops, while 23 percent would pay themselves.
That preference fits the Medicaid reality. For most members, the covered path through a clinician is the practical one, and it begins with a single question at door one or door two.
The right answer is individual
This comparison is about navigation, not about whether esketamine will help you. Some people are not candidates because of blood pressure, certain vascular conditions, or other health factors. A clinician who knows your history makes that call.
If the depression has led to thoughts of suicide, set the navigation aside for now. Anywhere in the country, 988 by call or text reaches the free, around-the-clock Suicide and Crisis Lifeline, where veterans have a press-1 option.
Methodology
Our survey went out to Pollfish's panel of consumers, ended on June 23, 2026, and gathered 443 completed questionnaires, filled out by people aged 18 to 64 in Wisconsin, Minnesota, Indiana, Nebraska, Iowa, Missouri, Kansas, Illinois, Oklahoma, and Ohio. Results are whole-sample except the Medicaid figure, with no state-level breakdowns. The coverage question was multi-select. Numbers here trace to Pollfish's validated final responses, and our publisher both commissioned and paid for this study.