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Using Medicaid for Drug or Alcohol Treatment

What is Medicaid?

Medicaid is a federal health insurance program providing health coverage to eligible individuals, including low-income adults and children, pregnant women, the elderly, and those with disabilities.1 If you have Medicaid, you are one of the 75.9 million Americans who are covered by this state-run insurance program.1 Although this program is funded by both the federal and state governments, the states manage the program and set the terms for eligibility.

In addition to providing coverage for a myriad of health services, Medicaid also provides coverage for behavioral health services. In fact, according to their website, Medicaid is the United States’ largest single payer for mental health services.2 Additionally, it is playing a larger role in substance use disorder services reimbursement, which means that you may be able to use Medicaid to cover some or all of the cost of medical detox and drug and alcohol treatment.2

Does Medicaid Cover Addiction Treatment?

Many enrolled in Medicaid may wonder if it able to cover drug rehab or other substance abuse treatment programs. Unfortunately, the answer isn’t always clear-cut. Medicaid is independently administered by each state and there are different plans available. This means that Medicaid coverage may vary based on the plan you have, your location, and the facility at which you receive care.1 Be sure to call the number on the back of your card to verify your benefits and coverage before seeking care. That can help you avoid unexpected medical bills and keep your health care costs as low as possible.

Despite this, under the Affordable Care Act, all health plans, including Medicaid, must provide some level of coverage for mental and behavioral health services, including substance use disorder treatment (which includes the cost of detox and addiction treatment).3 This means that some or all of your addiction treatment may be covered by your Medicaid plan.

Types of Addiction Treatment Medicaid Covers

The types of addiction treatment covered, and the extent to which they may be covered, will vary based on your plan, your location, and the facility at which you receive care. However, the following list includes a variety of common addiction treatments:4

  • Medical detox. Detox is often the first step in the recovery process. It is the process of the body clearing itself of substances (in this case, drugs or alcohol). This treatment should be done under the care of medical professionals, as it often is accompanied by unpleasant and potentially life-threatening side effects.4
  • Inpatient and residential rehab. Inpatient and residential rehab often involve a patient staying at a facility for a short time (inpatient, a few days to weeks) or a long time (residential, weeks to months), where they’ll receive 24/7 care for their addiction.4
  • Outpatient rehab. This type of care often includes a wide variety of patient programs that occur on a schedule, like therapy, to help patients stay the course on their recovery.5
  • Mental health services. This broad term refers to a variety of different types of mental health care services, including those mentioned above, therapy, medication-assisted treatment, and more. Talk to your provider to see what mental health services may be right for you.
  • Aftercare. This often refers to a recovering patient continuing to receive care even after going through detox, inpatient, or outpatient care to stay the course of sobriety and recovery.6

Your provider may recommend other types of treatment depending on your personal situation. Be sure to work with them to come up with a treatment plan that makes sense for you.

How To Check Your Medicaid Coverage

There are a wide variety of ways that you can check your Medicaid addiction treatment coverage. For example, you can call the number on the back of your insurance card to speak to a representative from Medicaid’s member services, or you can verify your benefits through your web login and online portal. You may also be able to call the detox provider of your choice and ask a staff member there to help you check whether Medicaid will cover your treatment there. Finally, there are several sites that allow you to check your insurance coverage online.

How To Use Medicaid for Addiction Treatment

If you’re seeking addiction treatment, using your insurance may be the most cost-effective strategy to pay for detox or rehab services. However, the insurance world can be confusing and complex. It’s important to remember that because Medicaid is state-run, the process for using it to pay for treatment may vary by state. It is therefore advisable to direct specific questions to your state’s Medicaid agency.

To use your coverage for addiction treatment, Medicaid recommends calling the member services phone number on the back of your Medicaid insurance card or on your eligibility letter that you may have received upon enrollment.7 You can also call the facility at which you’re receiving care to speak to a staff member who may be able to help you determine what services are covered by your plan. In some cases, depending on your plan or location, you may be required to obtain a preauthorization or referral before coverage for your treatment kicks in.7

Does Medicaid Require Treatment Centers To Be In-Network?

How each state runs its Medicaid program will vary, and this extends to its provider networks. Typically, in-network rehab centers and detox programs are the most cost-effective for both the plan and the covered individual.8 This means that if you go to an in-network provider, your care may be covered at a higher percentage, which translates to lower out-of-pocket costs to you, if applicable.8 While some Medicaid plans will allow some level of coverage for out-of-network providers, others may not.8 That’s why it’s so important that you check with your state’s Medicaid office to verify your coverage.

To reiterate, Medicaid plans vary by state. What is considered in-network will not be the same from state to state, nor will what is considered out-of-network. This holds true for coverage out of state. Moreover, how each state treats coverage for out-of-network providers will also vary. Please check with your state’s Medicaid office for the most accurate information.

Medicaid Eligibility by Income

Not everyone is eligible for Medicaid, and eligibility is primarily based on income levels.9 As with many other aspects of Medicaid, income guidelines vary by state.9 Be sure to check with your state’s Medicaid office to confirm eligibility requirements.

While state eligibility levels will vary, listed below are the federal guidelines for Medicaid eligibility. Please note that these are guidelines, not requirements.10

  • $12,880 for individuals
  • $17,420 for a family of 2
  • $21,960 for a family of 3
  • $26,500 for a family of 4
  • $31,040 for a family of 5
  • $35,580 for a family of 6

Can Veterans Qualify for Medicaid?

While it may depend upon your specific situation, in the majority of cases, veterans who are eligible for VA benefits, including health care benefits, can still enroll in a Medicaid plan.11 Having Medicaid and VA health benefits ensures that you will have some level of coverage for care that you receive, no matter what facility you visit to receive that care.

Detox Centers Near Me That Accept Medicaid

If you’re ready to take the next step on your journey to recovery, congratulations. Prioritizing the care that you need is always a great idea. After you’ve checked your insurance benefits and coverage, the next step is often related to finding rehab centers that take Medicaid near you. While this may seem complicated, there are a handful of resources available to you, and there are even some online that you can use.

If you still have questions about rehab and Medicaid, American Addiction Centers (AAC) operates a 24/7 detox hotline. Our trained staff can help answer any questions you may have about the treatment process, connect you to a facility that meets your needs, and help you verify whether the facility accepts your Medicaid plan.