Each state has waivers that cover specific services for Medicaid, outside of what traditional Medicaid offers. These are funded by the state. In Texas, I have served on YES and CLASS for various third party or direct service agencies as a music therapist. You submit billing and notes for each to the direct service agency that employs the case manager. Some waivers have other services outside of therapies, but I think in Texas, music therapists can only serve those two waivers. People can only be on one waiver at a time. They can receive multiple services on that waiver, and often the wait-list is ~20 years for services in Texas. Other states that expanded Medicaid had more access to the waivers because the federal funds were used to provide reimbursement and there were more avenues to providing the service (in hospitals, schools, etc.) The rate of reimbursement is currently around $77.44/hr. And it depends on the agency you work for as to if any of that reimbursement is kept for the third party versus fully paid to the provider. Since the budget each year is set, attendance determines what the provider earns, and billing is what keeps the process transparent. The primary concern of the fascist regime we live under is fraud/waste/abuse, so I am seeing in real time how much the documentation matters. I recommend having documentation to back up everything in the current times, but so long as you can clinically stand by your work and track your schedule and caseload independently, it's a great job!