Medicaid Insurance Coverage For Drug And Alcohol Rehab

Medicaid is a state- and federally-funded health insurance program available for low-income adults, children, pregnant women, elderly adults, and people with disabilities.

Many drug and alcohol rehab programs are covered by Medicaid depending on a few factors, such as state coverage, eligibility for Medicaid, and financial need.

Is There Medicaid Coverage For Alcohol And Drug Rehab?

Medicaid covers many alcohol and drug rehab programs.

In 2010, the Affordable Care Act (ACA), also known as “Obamacare,” mandated that insurance providers cover behavioral health services, including rehab.

However, Medicaid plans vary by state and may not cover all treatment programs. Additionally, not all rehab centers will accept Medicaid as a form of payment.

What Addiction Treatment Services Are Covered By Medicaid?

Depending on the state, there are a few primary addiction treatment services covered by Medicaid.

According to Medicaid.gov, almost 12% of beneficiaries over age 18 have a substance use disorder (SUD). Medicaid accounted for 21% of national spending for treating SUDs in 2009.

Medicaid covers the following substance abuse and mental health treatment services:

• prescription drugs
• case management
• individual and family counseling
• support groups
• rehabilitation services
• screenings and assessments

Medical Detox

Medicaid covers medical detox, a supervised program that allows a person to safely purge toxins from substances. This usually lasts five to 10 days.

Detoxification can be done in a medical setting, at home, or by quitting cold turkey (not recommended). Detoxing without medical supervision can be very dangerous.

The safest option is to participate in medical detox, where trained staff can administer medications and monitor withdrawal symptoms.

Outpatient Rehab Programs

Outpatient treatment programs are also covered by Medicaid. This is a part-time option in which a person receives treatment at a rehab center and returns home.

Levels of care include:

• standard outpatient program (OP)
• intensive outpatient program (IOP)
• partial hospitalization program (PHP)
• aftercare/continuing care

Inpatient Rehab Programs

Some inpatient treatment programs can be covered with Medicaid. This is a residential treatment option that usually lasts 30, 60, or 90 days.

At an inpatient rehab center, a person will live in the rehab facility and participate in various addiction treatment programs, such as group therapy, family sessions, and vocational training.

Medication-Assisted Treatment (MAT)

MAT combines medication with behavioral therapies to provide a whole-patient approach to addiction recovery.

Medications often used in MAT programs include:

• buprenorphine (Suboxone, Zubsolv, Subutex) or methadone for opioid dependence
• Disulfiram or naltrexone for alcohol dependence

Factors That Affect Medicaid Coverage For Addiction Treatment

While many states offer Medicaid coverage for substance abuse treatment, there are several factors that may impact a person’s chances of getting into a rehab program using Medicaid.

Prior Authorization

Some people may need to get prior authorization (PA) for rehab coverage. Prior authorization requires approval from Medicaid before starting a new medication or program.

Each state has different PA requirements for Medicaid coverage. Many states have a PA lookup tool so people can find out what requirements are needed.

Copays, Premiums, And Deductibles

Medicaid coverage usually does not come with a copay or premium. However, some services require cost-sharing with copays, premiums, deductibles, or other charges.

Depending on your plan and state’s coverage, you may be required to pay part of the substance abuse treatment program or prescription medication cost out of pocket.

These charges are limited, but states can charge higher fees for individuals with higher incomes. Children and pregnant women are exempt from these charges.

Understand There May Be Long Waitlists

When a person is looking to enroll in a program using Medicaid, there may be long waitlists.

This can be due to a smaller capacity of the rehab center or a small number of Medicaid members allowed in the program.

Some waitlists can be just a day or two, while others can last weeks or months depending on the program.

Finding A Medicaid Rehab Center

There are usually only a few rehab centers in each state that will accept Medicaid as a form of payment.

It may be challenging to locate a quality rehab facility that offers everything you need and accepts Medicaid.

Meeting Medicaid Eligibility Requirements

To use Medicaid, a person must be in one of the low-income eligible groups.

Those eligible for Medicaid include:

• children 18 and younger
• pregnant women
• parents
• seniors 65 or older
• individuals with disabilities and their family members

Medicaid Income Eligibility Requirements

To be eligible for Medicaid, a person must fall into one of the covered groups and the correct income bracket for each state.

Each state has different income eligibility requirements, and this will affect a person’s ability to use Medicaid to cover behavioral health services such as drug and alcohol addiction treatment.

Modified Adjusted Gross Income (MAGI)

The MAGI is what’s used to determine a person’s financial eligibility for Medicaid services.

MAGI considers taxable income and tax filing relationships. It’s very similar to a person’s adjusted taxable income.

MAGI considers the following information from each tax-filing individual in a household:

• adjusted gross income (AGI) on a federal tax return
• excluded foreign income
• nontaxable Social Security benefits
• tax-exempt interest

Supplemental Security Income (SSI) is not counted toward MAGI.

The following groups are exempt from MAGI-based income counting rules:

• a person who is blind
• a person with a disability
• a person who is 65 or older

What’s The Income Cutoff?

The gross income cutoff varies by state. Most cutoffs hover around $15,000 in annual income for a single-person household, and about $50,000 for an eight-person household.

Making An Appeal

If you’ve been denied Medicaid coverage for behavioral health services, you can make an appeal and try again.

With an appeal, you can request a fair hearing if you believe the denial was wrong.

Medicaid Plans By State

Medicaid is a nationwide program, but each state has its own name.

The following list provides the names of each state’s Medicaid program:

• Alabama: Medicaid
• Alaska: DenaliCare
• Arizona: Arizona Health Care Cost Containment System (AHCCCS)
• Arkansas: Medicaid
• California: Medi-Cal
• Colorado: Health First Colorado
• Connecticut: HUSKY Health
• Delaware: Diamond State Health Plan
• Florida: Statewide Medicaid Managed Care Program
• Georgia: Medicaid
• Hawaii: Med-QUEST
• Idaho: Medicaid
• Illinois: Medical Assistance Program
• Indiana: Hoosier Healthwise; Hoosier Care Connect; M.E.D. Works; Healthy Indiana Plan (HIP); Traditional Medicaid
• Iowa: IA Health Link
• Kansas: KanCare
• Kentucky: Medicaid
• Louisiana: Healthy Louisiana (previously Bayou Health)
• Maine: MaineCare
• Maryland: Medical Assistance
• Massachusetts: MassHealth
• Michigan: Medical Assistance (MA)
• Minnesota: Medical Assistance (MA); MinnesotaCare
• Mississippi: Mississippi Coordinated Access Network (MississippiCAN)
• Missouri: MO HealthNet
• Montana: Medicaid
• Nebraska: Heritage Health
• Nevada: Medicaid
• New Hampshire: Medical Assistance
• New Jersey: NJ FamilyCare
• New Mexico: Centennial Care
• New York: Medicaid Managed Care
• North Carolina: NC Medicaid
• North Dakota: Medicaid
• Ohio: Medicaid
• Oklahoma: SoonerCare
• Oregon: Oregon Health Plan
• Pennsylvania: Medical Assistance (MA)
• Rhode Island: Medicaid; Medical Assistance (MA)
• South Carolina: Healthy Connections
• South Dakota: Medicaid
• Tennessee: TennCare
• Texas: Medicaid
• Utah: Medicaid
• Vermont: Green Mountain Care
• Virginia: Medicaid
• Washington: Apple Health
• Washington D.C.: Medicaid; DC Healthy Families (Health Care Alliance)
• West Virginia: Medicaid
• Wisconsin: ForwardHealth; BadgerCare
• Wyoming: Equality Care

Medicaid Insurance Coverage For Drug And Alcohol Rehab FAQs

Here, you’ll find answers to some of the top asked questions about Medicaid coverage of drug and alcohol rehab.

Does Medicaid Cover Drug Rehab Services?

Medicaid does cover the cost of drug and alcohol treatment facilities. However, not all recovery centers accept Medicaid, so it may take longer to find a treatment program that will take it.

Are There Any Addiction Services Not Covered By Medicaid?

Medicaid covers most mental health services, including therapy, medication management, peer supports, and treatment for substance use disorders.

But each state decides which services to cover. Your state may not include all of the above services.

What Are The Prescription Drugs Covered By Medicaid?

There are several prescription medications often used in the treatment of drug and alcohol addiction.

Depending on the state, Medicaid usually covers:

• Suboxone
• Subutex
• Zubsolv
• buprenorphine (generic)
• buprenorphine/naloxone (generic)
• methadone

Find Drug Rehab Centers That Accept Medicaid

If you or a loved one want to learn more about Medicaid coverage for addiction treatment services, reach out to us. Our representatives are ready to take your call to discuss treatment options.

Addiction treatment is available for those struggling with alcohol and drugs, just call our helpline today to get started.