Arizona Health Care Cost Containment System (AHCCCS) for Drug Rehab

The Arizona Health Care Cost Containment System (AHCCCS) is the state’s Medicaid program. It provides health care coverage for lower income individuals and families in Arizona.

Medicaid was enacted by the federal government in 1965. States were not required to participate but since 1982 all states have had Medicaid programs. Arizona started AHCCCS on October 1, 1982 and was the final state to start a program. Behavioral health services started to be covered by AHCCCS in 1990 and the children’s focused CHIP program was started in Arizona in 1999.

Today Arizona’s Medicaid program covers a wide range of medical and behavioral health services. You will choose a plan that covers your zip code and then you’ll get care from a group of providers and doctors that have agreed to accept the plan.

Does AHCCCS Cover Addiction Treatment?

Like all Medicaid plans AHCCCS does cover addiction treatment and treatment may be available at little or no cost. However there are limitations. You must have a primary care doctor who is an authorized provider for your plan within your zip code. Your doctor will make referrals for both your medical and mental health services which are usually determined by what is considered medically necessary care.

Covered behavioral health services include day treatment programs and crisis services including inpatient and residential urgent care. They also cover substance abuse treatment including assessments and counseling using scientifically proven therapies. Medical detox with medication assisted treatment (MAT) is also eligible for coverage.

What Inpatient Addiction Treatment Does AHCCCS Cover?

Medicaid plans, including AHCCCS, cover inpatient treatment in a hospital or clinic setting, as well as residential treatment in a more home-like setting, when 24 hour care and supervision are medically necessary. Limitations on the number of inpatient days covered will vary according to individual insurance plans but 30 days per year is typical.

Your primary care doctor must certify that inpatient or residential treatment is medically necessary. An example of medical necessity is when detoxification for withdrawal is needed and requires around the clock supervision due to the severity of withdrawal symptoms.

Other examples include the presence of additional co occurring psychiatric or medical conditions or when other difficulties such as a lack of social support exist. In addition to a referral from your primary doctor having a detailed treatment plan from the doctor outlining the reasons for the suggested treatments is also important for securing authorization.

Inpatient and residential treatment providing medical detox must use FDA approved medications such as methadone or buprenorphine or naltrexone. Medical detox safely removes drugs from the body while relieving cravings and other withdrawal symptoms and rebalancing brain chemistry. It is most often used in combination with counseling.

After medical detox you might move on to inpatient or residential treatment. This is where you live at the treatment facility and participate in individual and group therapy. Counseling using evidence based therapies such as cognitive behavioral therapy and motivational interviewing along with dialectical behavioral therapy are approved for coverage in Medicaid insurance plans.

Patients who receive medical detox treatment as well counseling are more likely to complete their follow up addiction treatment programs.

What Outpatient Rehab Does AHCCCS Cover?

AHCCCS Medicaid plans cover medically necessary outpatient treatment. Insurance plans vary so check with your provider about the specifics of your plan. Outpatient options may include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and general outpatient programs.

PHPs or day programs involve attending treatment during day hours and returning home at night. Programs typically run 4 to 8 hours each day for three to four days a week over 30 to 90 days.

Intensive outpatient programs typically provide 9 to 20 hours of treatment a week conducted over 3 to 5 days each week. The entire program is usually 90 days.

General outpatient programs take place in a clinic or rehab facility. Counseling sessions are provided one or more times per week for an average of two to three hours of treatment each week. Group counseling sessions are typical with individual sessions added as needed.

Aftercare services may involve additional counseling sessions and 12 Step peer group meetings along with alumni meetings. These are often provided following an outpatient program. Such services aid in relapse prevention efforts and provide ongoing social support.

AHCCCS Medicaid plans also offer special outpatient opioid treatment services that are available 24 hours a day, seven days a week at four Arizona locations. Links to 24/7 Access Point locations can be found on the AHCCCS website. These Access Points will help you get started with treatment.

A link to Peer and Family Support Services — where you can access the services of a peer recovery support specialist who can offer support and information on local resources — can also be found on the same AHCCCS web page.

Does AHCCCS Cover Methadone & Suboxone (MAT)?

AHCCS Medicaid plans cover FDA approved medication assisted treatment (MAT) medications when they are appropriate for your needs. Both methadone and suboxone are FDA approved as MAT medications, and they are covered for use in the treatment of opioid use disorder.

MAT is most useful for those struggling with opioid or alcohol misuse. The medications can help you detox and can also be used on a longer term basis to help you stay stable during treatment. This allows you to lay a strong foundation for recovery and eventually you can slowly stop using the medication support and live a truly substance free life.

Does AHCCCS Cover Other Mental Healthcare?

Besides substance abuse treatment there are other mental health services offered by AHCCCS Medicaid plans. For example you can get counseling and support for the treatment of depression or anxiety or other mental health disorders. This may include medication for the mental health condition.

Medicaid also covers health promotion services such as education about illness and and healthy lifestyles as well as stress management. Also included are case management services such as help accessing community resources or applying for benefits as well as interpreter services and transportation. You can also connect to community housing support and respite care.

In addition AHCCCS covers treatment for co occurring disorders. A co occurring disorder is when mental health issues such as anxiety and depression or PTSD or eating disorders are diagnosed in addition to substance use.

Treating co occurring mental health conditions simultaneously with addiction provides the greatest likelihood of long term recovery. Remember that you will need to get preauthorization through a referral from your primary care doctor and you’ll need to use a treatment provider who accepts Arizona Medicaid.

How Long Will AHCCCS Cover Rehab?

How long your addiction rehab treatment coverage lasts will depend on the type of treatment you have and what your specific insurance plan offers as well as the treatment that is ordered by your primary care physician. Only medically necessary treatment is covered.

On average inpatient treatment is covered for a few days to two weeks and residential treatment is covered for 30 days. Outpatient treatment is generally covered for 90 days. But you must check the details of your own plan for specifics. No matter what kind of program you are in and how long it lasts, your best chance for long term recovery will come from embracing the process and completing your entire program as scheduled.

Can I Travel Out of State For Treatment With AHCCCS?

Because no Medicaid programs cover out of state treatment you must use a provider that is in the Medicaid network based on your zip code if you want AHCCCS coverage.

Arizona’s AHCCCS Medicaid plans have many high quality providers so staying within your provider network should not be a problem. In doing so you will have the benefit of AHCCCS’s low cost or no cost treatment services.

How to Find In Network Addiction Treatment With AHCCCS

To find in network treatment start with your primary care provider. Your primary doctor will be able to make a referral that best fits your needs and that is convenient for you as well.

In addition if you are looking for opioid treatment or if you want to access the services of a peer recovery support specialist, you can find links to these resources on the AHCCCS website.

What to Do if AHCCCS Won’t Cover the Cost of Rehab

Most of the time, you should be able to find appropriate services available from an in network provider referred to you by your primary care doctor. However if this is not the case — or if you choose to use an out of network provider — you will be responsible for covering the cost of treatment yourself. Some rehabs offer reduced fee sliding scale payments based on income which might make self payment affordable for you.

For those who don’t have insurance AHCCCS offers information and phone numbers for non insured treatment options. These options prioritize people with special needs such as pregnant women and teens as well as individuals who take drugs by injection and women with dependent children who are trying to regain custody of their children. But funding is available to others, as well.

You might be eligible for financial assistance through a grant or scholarship. These are offered by individual treatment centers as well as advocacy groups such as groups that advocate for LGBTQ+ individuals. Your church might be another source of financial assistance.

The Salvation Army Rehabilitation program is a free option that allows you to work in exchange for treatment in their addiction program. Visit the Salvation Army website to find links to their rehabilitation centers.

Finally you could consider using credit or a loan to pay for treatment. CareCredit is a company that markets credit cards specifically intended to be used to pay for healthcare treatments. You could alternately consider borrowing money from family or friends.

Because it is important to get the rehab you need be sure to be diligent in your search for both treatment and funding and consider all available options.