Medicaid Health Insurance Coverage for Addiction Treatment

You may know Medicaid as the government health insurance program for people and families with low income. Medicaid was created by the federal government in 1965.

While federal law sets guidelines about what Medicaid programs need to look like they’re ultimately run by state governments. If you’re looking to get Medicaid you would need to sign up through your own state. Many states have specific insurance companies that provide their Medicaid plans and that insurer can answer questions about the details of your plan.

Does Medicaid Cover Drug Rehab & Addiction Treatment?

Yes. The Affordable Care Act and Mental Health Parity and Addiction Equity Act oblige all Medicaid plans to cover mental health and substance use and to cover it at the same level as they cover medical treatment. It applies to Medicaid. Therefore if you have Medicaid you have access to addiction treatment.

Each state can decide within federal guidelines what addiction treatment coverage will look like and who will administer it. You will need to make sure that the treatment center you’re considering takes Medicaid as many don’t. If they do take it keep in mind you may also need prior authorization from Medicaid or the company managing it before you can go.

There are also substance use rehab programs specifically for those with Medicaid. They may be run by nonprofits, the county, or the state. Often these programs will include additional support through community services and resources that benefit lower income individuals and families.

Does Medicaid Cover Methadone and Suboxone Treatment?

Federal Medicaid rules do specifically mention coverage of methadone treatment and other medications for treating opioid addiction. All Medicaid programs will cover medications for opioid use disorder including methadone, buprenorphine and naltrexone. They will also cover the other aspects of medication assisted treatment (MAT) such as counseling and therapy groups.

As with other drug rehab options it’s important to ensure the MAT program accepts Medicaid coverage before you commit to treatment.

Who Does Medicaid Cover?

Medicaid eligibility rules vary by state, but there are some commonalities. In general, Medicaid covers children, adults, and people of native origin. All Medicaid programs have income limits based on household size and some may have asset limits as well.

Every state has a Medicaid program for children. Your children may be able to qualify for Medicaid even if you can’t, which can help them get essential healthcare as they grow and attend school.

In many states you can qualify for Medicaid as a low-income adult without children. The Affordable Care Act offered funding to states that chose to expand their Medicaid eligibility. Many states chose to accept the funding. In those states you can qualify for Medicaid if your annual income is 138% or less of the federal poverty level. In some states, you can also qualify for Medicaid if you’re elderly or disabled and have a lower income.

Some states have a program that will allow you to get Medicaid if you’re the parent or caretaker of someone who gets Medicaid. To qualify, your income would need to be below a certain annual amount that the state determines.

If you’re an American Indian or Alaska Native, the same criteria for Medicaid eligibility applies to you as to people who aren’t tribal members. One important thing to note is that you don’t lose your IHS health services if you get Medicaid. You can still go to see the care team you know if they accept Medicaid coverage. With Medicaid, you’ll be able to get other health services as well, like drug rehab outside your IHS clinic.

How Can I Sign Up for Medicaid?

If you want to sign up for Medicaid, you need to follow the instructions specific to your state. Some states run their Medicaid programs themselves. Others rely on private companies to manage their benefits.

When a private company manages Medicaid benefits, it’s referred to as “managed Medicaid”. If you’re in a state that uses managed Medicaid, you might have to qualify for Medicaid through the state and then sign up for benefits with a company. You can find a state by state guide for how to sign up on the federal Medicaid website.

What Types of Inpatient Rehab Does Medicaid Cover?

When you focus fully on your rehab in a hospital or home like setting that’s known as inpatient or residential treatment. Medicaid generally covers this treatment when your doctor says it’s necessary. There might be limits to the length of stay or specific benefits depending on your plan.

Inpatient and residential treatment facilities often offer medical detox with medication assisted treatment (MAT), using FDA approved medications including methadone buprenorphine and naltrexone. MAT detox is usually done in an inpatient setting or residential setting when the patient is at risk for severe withdrawal symptoms or has other medical or mental health issues that might complicate treatment which makes the availability of 24 hour supervision and monitoring important.

Counseling and psychotherapy are usually part of inpatient or residential treatment. Medicaid covers evidence based therapies such as cognitive behavioral therapy, motivational interviewing, and dialectical behavioral therapy.

What Types of Outpatient Addiction Treatment Does Medicaid Cover?

Outpatient treatment that takes place in a facility that does not provide overnight stays is covered by Medicaid. This can include regular outpatient, day treatment, and intensive outpatient treatment. But services differ according to the HMO provider. MAT treatment delivered as outpatient detox or as ongoing withdrawal medication management during outpatient care are covered. Individual, group, and family counseling are covered if these are delivered using evidence based therapies. Keep in mind that Medicaid does not cover alternative or unproven therapy.

Your Medicaid plan will take care of health screenings to diagnose you and drug and alcohol testing while you’re in rehab. If you have a mental health diagnosis along with substance use Medicaid will cover integrated care that addresses both problems at once.

Depending on your plan and the state you might also be able to get case management services such as assistance finding housing and skills training to prepare for a job. Aftercare peer support that is offered through peer coaching services may also be covered, depending on your insurance plan.

Can I Travel Out of State For Treatment With Medicaid

Medicaid benefits are generally not transferable out of state except that hospitals are required by law to accept patients and provide medical services during an emergency situation where the patient’s life is at risk and travel to their home state for treatment would not be possible.

For non emergency out of state Medicaid coverage you would likely have to get a referral from your physician and an authorization from your insurance provider. This is rare so it’s best to find treatment providers within the network.

What Can I Do if Medicaid Won’t Cover the Cost of Rehab?

Medicaid generally covers the cost of rehab fully in programs that accept Medicaid coverage. If you find that your service is being denied you can appeal. States and individual Medicaid HMOs have different appeal procedures so it is a good idea to check with a lawyer or an advocacy organization if you need assistance.

If you want to attend a treatment program that doesn’t accept Medicaid you’ll need to find another way to pay. Fortunately there are a lot of options. Some treatment plans have a sliding scale where they charge you less if you need assistance. There could be SAMHSA grants or scholarships available from the rehab center.

Also, your family might be able to help you out. The focus is to get the care you really need because once you’re in recovery you’ll be far better able to manage your finances.