Using Medicaid to pay for addiction treatment can alleviate many of the financial stressors associated with entering recovery. Before finding rehab centers that accept Medicaid, it may first be helpful to understand which addiction treatment services are covered.
For eligible individuals, Medicaid insurance plans can provide coverage for drug and alcohol addiction treatment. Amount of coverage varies by the plan, and eligibility for Medicaid varies by state requirement.
Medicaid is a state- and federally-funded health insurance plan that provides health care coverage for individuals who qualify. Finding rehab centers that accept your Medicaid insurance plan before heading to treatment can ease the process of selecting and paying for a program.
Does Medicaid Cover Alcohol And Drug Rehab?
Medicaid is an insurance coverage program for low-income individuals. Because the program is state-funded and state-run, the program has very specific guidelines for what will be covered for addiction treatment. This will vary by state and by patient need.
The 2010 Affordable Care Act (ACA) instituted under Obamacare made possible basic coverage of addiction treatment services. The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) also began a new standard of health coverage by requiring that all individual and group insurance health plans provide coverage for addiction treatment to the same degree they would cover other health issues.
Get Your Treatment Covered By Medicaid Today.
Addiction Treatment Services Covered By Medicaid
Those who qualify for Medicaid generally do not have a copay for treatment services. For those who do have copays, there is a set out-of-pocket maximum they will be expected to pay. Copay amounts vary by state.
While Medicaid provides coverage for addiction treatment services for individuals who need it, those receiving treatment may have to complete an assessment to prove medical need. The following are treatment services covered by Medicaid:
- dual diagnosis treatment
- drug testing
- family counseling
- mental health treatment
In addition, Medicaid covers major addiction treatment needs, including inpatient rehab programs, outpatient services, and medication-assisted treatment. Coverage may depend on verified medical need and may be limited to care within a certain, eligible rehab center.
If you want to use Medicaid to seek treatment for substance abuse or addiction, it may be worthwhile to know if your plan covers the following major treatment methods.
Inpatient Rehab Programs
Inpatient rehab programs may be covered by Medicaid, but the amount of coverage and eligible rehab centers will vary by state. Within inpatient treatment (also called residential), individuals stay onsite at the rehab facility for a number of days or weeks until treatment is completed. Participants may take part in a number of therapies, counseling, detoxification, medication-assisted treatment, and more.
Often, Medicaid coverage for inpatient addiction treatment will depend on which rehab center a person chooses to attend. Many private rehab facilities will not accept Medicaid, but a select few do.
State-funded rehab centers typically accept Medicaid to provide free or low-cost addiction treatment to those in need. However, these facilities may have long waiting lists, so it’s best to research these rehab centers prior to seeking treatment.
Length of stay for an inpatient program covered by Medicaid may be very specific, such as 28 or 30 days. Longer stays may be approved according to patient need. Speaking to a treatment specialist to determine the exact amount of inpatient stay covered by Medicaid can help avoid any surprise or excess fees or costs during treatment.
Some Medicaid plans may require those heading to addiction treatment for the first time to try outpatient treatment first. Outpatient treatment is facilitated at a rehab center and offers some of the same methods as an inpatient but on a less intensive scale. Participants generally attend outpatient programs a number of days per week for two to three hours at a time.
Medicaid plans may provide coverage for a number of outpatient services, such as counseling, therapy, and medication maintenance programs with buprenorphine (Suboxone) or methadone. As with other services, amount of coverage and eligibility requirements vary by each state’s Medicaid plan.
Certain outpatient programs may be covered at a higher rate than others. For instance, intensive outpatient programs (IOP) and partial hospitalization programs (PHP) provide a form of treatment similar in intensity to inpatient but at a greatly reduced cost. This increases the chances of Medicaid coverage for these programs.
Medication-Assisted Treatment (MAT)
Many individuals in addiction treatment need some form of medication to help alleviate cravings and other withdrawal symptoms and help keep them dedicated during the early stages of recovery. This form of treatment is known as medication-assisted treatment (MAT).
Medicaid coverage for medication-assisted treatment also varies by state plan, as some plans may not cover it at all, while others may cover it for a time with strict guidelines, such as which medication will be covered and for how long.
Using Your Medicaid Plan To Cover Addiction Treatment
If you want to use your Medicaid plan to cover addiction treatment, it’s important to consider some key factors. First, make sure you choose a rehab center that accepts Medicaid. Not all rehab centers will comply with Medicaid coverage, and it’s best to know this before heading to rehab.
Talk first with a treatment specialist or your Medicaid provider to ensure you have everything in place before heading to treatment. This can include getting an assessment from a primary care provider (PCP) or getting the necessary paperwork in order.
Whatever is needed, it is helpful to have all factors in place before beginning treatment. Figuring out how to pay for addiction treatment using Medicaid will provide some financial relief and ease some of the concern associated with entering treatment.
Questions To Ask Before Using Medicaid To Pay For Rehab
Entering addiction treatment can be the best decision you make for your life and your recovery. But, it can also come with some understandable concerns. One of the biggest factors that keep people from entering treatment is cost. If you use your Medicaid plan to pay for treatment, you can alleviate most or all of these costs.
However, there are some questions you should prepare to ask of a treatment specialist, care provider, or insurance provider prior to treatment start. This way, you will have no hidden costs or fees, will know exactly what you’re expected to pay, and can have the financial burden of paying for addiction treatment lifted.
Questions to ask when using your Medicaid to pay for rehab include:
- Does my Medicaid plan cover inpatient drug rehab? If so, what length of stay is covered?
- Does my Medicaid plan cover detox? If so, is medication also covered?
- Does my plan cover medication-assisted treatment or medication maintenance?
- For continued care, does my Medicaid plan cover outpatient services? Which types?
- What is my responsibility: what are my copays, premiums, or deductibles, if any?
- Do I need to complete a clinical assessment to prove medical necessity?
- What paperwork do I need to send to my Medicaid provider prior to going to rehab?
Medicaid Eligibility Requirements
Medicaid has very specific eligibility requirements. In general, Medicaid is available to those individuals who are below a certain income level and who meet one or more of the following eligibility requirements:
- youth or adolescent under 19 years of age
- senior age 65 or older
While most states require individuals receiving Medicaid to be both low-income and to meet one of the above requirements, some states provide Medicaid coverage to all individuals who meet income requirements.
To be considered low-income, individuals must be considered below the federal poverty level (FPL) as determined by the Affordable Care Act. However, an individual may still be eligible to receive Medicaid above the federal poverty level if they fall within a certain income bracket. To know for sure if you qualify for Medicaid coverage, speak to a treatment specialist or state Medicaid provider.
How To Find A Rehab Center That Accepts Medicaid
Using insurance to pay for addiction treatment may feel confusing and frustrating, but it doesn’t have to be a complex process. Insurance can help reduce or eliminate the cost of addiction treatment, alleviating one of the biggest concerns most individuals have about entering recovery.
If you are considering entering addiction treatment and you’re worried about cost, do not let this worry keep you from beginning your new sober phase of life. Contact a treatment specialist today to learn more about rehab centers that accept Medicaid.
* Disclaimer: RehabCenter.net is not affiliated with or endorsed by Medicaid. Details about Medicaid’s coverage are intended for informational purposes only. The specific details of your plan may vary and the specific treatment services you require may or may not be covered.