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Medi-Cal Insurance Coverage for Drug and Alcohol Rehab

Medi-Cal is California’s Medicaid program, a state insurance coverage for lower-income individuals and families. If you’re struggling with substance misuse, treatment will be at least partially covered by your insurance policy. Learn more specific coverage information here.

What Is Medi-Cal Insurance?

Medi-Cal provides necessary health services for lower-income residents of California. Currently, there are 14 million individuals who receive Medi-Cal coverage.1 If you qualify for Medi-Cal, you can receive low- or no-cost coverage for your medical care.1

Some individuals have no monthly premium or out-of-pocket costs, while others have a low monthly premium and low copayments.2 Several benefits available are classified as essential health benefits. These include:3

  • Children’s health care, including dental and vision services, for those under 21.
  • Emergency services such as ambulance, emergency room care, and related treatment.
  • Hospitalization, which includes inpatient services, surgical care, and anesthesiologist services.
  • Laboratory services for testing and X-rays.
  • Maternity and newborn care such as prenatal, delivery, and postpartum care.
  • Mental health and substance misuse care, including inpatient and outpatient services and detox.
  • Outpatient services such as doctor’s appointments, outpatient surgery, chiropractic, and outpatient treatment.
  • Physical and occupational therapy.
  • Prescription drugs.
  • Preventive and wellness services such as immunizations, family planning, screenings, and smoking cessation.

Does Medi-Cal Cover Drug and Alcohol Rehab Treatment?

Yes. As noted above, mental health and substance misuse treatment are among the essential health benefits covered by Medi-Cal. If you live in an opt-in Drug Medi-Cal Organized Delivery System (DMC-ODS) county, you can receive treatments ranging from withdrawal management to residential treatment and other recovery services. If you do not reside in an opt-in DMC-ODS county, you can still receive coverage for outpatient services, intensive outpatient services, perinatal residential treatment, and narcotic treatment programs.4

Types of Addiction Treatment That Medi-Cal May Cover

Several treatment types may be covered by Medi-Cal, such as:

  • Medical detox: Medical detox helps patients withdraw from substances comfortably and safely to help facilitate the transition to ongoing addiction treatment.
  • Inpatient programs: Inpatient rehab provides intensive, structured care in a home-like setting. You will live at a facility for the duration of the program and attend individual and group therapy sessions during the day.
  • Outpatient treatment programs: In outpatient rehab programs, patients live at home while attending treatment to learn about addiction and how to maintain their sobriety.
  • Intensive outpatient program (IOP): Patients live at home with an IOP but attend more weekly treatment sessions than a standard outpatient program. This can help patients receive the additional care they need while still living at home.
  • Partial hospitalization program (PHP): A PHP offers a treatment structure similar to inpatient treatment. Patients attend treatment around 4 to 6 hours a day for approximately 5 to 7 days a week and live at home.
  • Aftercare: Aftercare programs provide ongoing counseling and treatment after patients attend rehab. The goals of aftercare programs are to help patients maintain sobriety.

Check Your Medi-Cal Rehab Coverage

The wide variety of treatment options can feel overwhelming but knowing exactly what your insurance will cover can bring you peace of mind. You can call the number on the back of your insurance card, verify your insurance online, or fill out the form below to check your coverage.

What Rehab Centers Take Medi-Cal Health Insurance?

If you would like to know whether your Medi-Cal plan may cover the full or partial cost of treatment at an American Addiction Centers (AAC) rehab center, you can check your coverage online, sign up for text support, or contact us at  24 hours a day.

Do Rehab Centers Need to be In-Network?

In-network rehab centers have agreed to accept your insurance coverage as payment for your treatment. Not all rehab centers make agreements with Medi-Cal, so it’s important to check before you commit to a program.

Out-of-network means that the rehab center does not have an agreement with the insurance company to provide discounted treatment. Although some insurance companies will provide some coverage for out-of-network providers, not all will. This means you will end up paying more out-of-pocket for treatment or potentially be responsible for paying in full.5 If you cannot find an in-network rehab center, you still have options including grants, loans, payment plans, scholarships, and more.

Does Medi-Cal Cover Mental Health Treatment?

The Affordable Care Act (ACA) defines mental health treatment, along with substance misuse treatment, as an essential health benefit. As a result, all long-term health plans, including Medi-Cal, are required to provide at least some coverage for mental health.6

It’s not unusual for someone to have both mental health concerns and substance misuse issues. When both occur in the same person, it’s known as comorbidity or a co-occurring disorder.7 Treating mental health along with substance misuse may include a variety of therapies, from psychotherapy (talk therapy) to group therapy to attending inpatient or outpatient rehab. The exact care you need will be best determined by your doctor.8

How Much of the Rehab Cost Does Medi-Cal Cover?

There’s no single answer to how much Medi-Cal will cover when it comes to drug or alcohol rehab. The details will depend on your medical needs, what Medi-Cal plan you have, and which rehab program you choose.

If you do not have the no-cost Medi-Cal coverage, you can expect to have a deductible, copayment, and other out-of-pocket costs. After you pay your out-of-pocket expenses, the insurance will cover the rest. Be sure you talk to your insurance provider and rehab center so you know exactly what will be covered.9

What Should I Do If the Cost of Rehab Is Not Fully Covered?

The cost of attending rehab may not be fully covered by Medi-Cal, but that doesn’t mean you shouldn’t attend treatment. There are other ways to cover potential costs left over after insurance. Many facilities offer sliding scale options. You can also research grants, loans, and scholarships. Rehab is an investment in your future, and the cost shouldn’t hold you back.

Getting Help for Drug or Alcohol Addiction

AAC is dedicated to helping individuals struggling with addiction achieve and maintain sobriety. If you are looking to learn more about addiction treatment or have questions about your Medi-Cal coverage, you can contact us at 24 hours a day.

 

More resources about Medi-Cal Insurance Coverage for Drug and Alcohol Rehab: