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Medicaid Coverage for Addiction Treatment

Medicaid is a federal- and state-funded program that provides healthcare coverage to people who meet its eligibility requirements. It provides coverage for addiction treatment, but the amount of coverage varies. Learn how Medicaid can help you get treatment for substance use disorder (SUD) below, or contact American Addiction Centers 24/7 at for confidential and free information.
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What Is Medicaid?

Medicaid is a federal- and state-funded program that provides healthcare coverage to people who meet its income and other eligibility requirements. Medicaid makes drug and alcohol rehab treatment more affordable by offering insurance to low-income people based on specific eligibility requirements. Medicaid substance abuse treatment coverage includes long-term inpatient care, prescription drugs, and outpatient services.1

In most cases, you must qualify for Medicaid based on Modified Adjusted Gross Income (MAGI).2 This method determines Medicaid eligibility for children, pregnant women, and adults. If you are over age 65, you are exempt from MAGI rules.

If you have Medicaid and Medicare, Medicare pays first, and Medicaid pays second if the services are not covered.3 Different types of Medicaid also cover care for different people. The Medicaid Expansion CHIP, for example, covers healthcare for children.

Who Is Eligible for Medicaid?

The following items may be used to determine eligibility for Medicaid:3

  • Financial eligibility: You must meet the financial requirements which may be determined by your Modified Adjusted Gross Income (MAGI). Some individuals are exempt like those eligible based on disability or age (65 and older).
  • Citizenship and residency: Medicaid beneficiaries must generally be residents of the state in which they are receiving benefits and must either be a citizen of the United States or be a qualified non-citizen.

Does Medicaid Cover Addiction Treatment?

Yes, Medicaid typically pays at least some part of drug and alcohol rehab treatment. State insurance typically covers rehab for most individuals. While Medicaid often covers substance use disorder (SUD) treatment, Medicaid addiction treatment coverage is also highly dependent on individual state policies. Additionally, Medicaid rehab coverage may vary depending on your insurance plan. The costs associated with SUD treatment may vary between Medicaid health insurance members by state.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in-network or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol rehab treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

Medicaid addiction treatment coverage is now accepted at many substance abuse treatment facilities across the country. Again, Medicaid may or may not pay your full rehab treatment costs, but it can make treatment more affordable at rehab facilities that accept Medicaid.4 Coverage may include:

  • Detox.
  • Screenings.
  • Inpatient and outpatient care.
  • Mental health services.

Typically, you will have no co-payment for drug and alcohol treatment. However, some states do require a co-pay. There will be a maximum co-pay that cannot be exceeded.

Additionally, Medicaid can also be a valuable asset for those who do not have private insurance, as it can allow them to access free or low-cost rehab centers. While everybody will find their costs to be different, Medicaid can help keep the cost of treatment low for low-income individuals.

Types of Substance Use Treatment That Medicaid Covers

With most Medicaid plans covering at least some of the costs of rehab treatment for drug and alcohol addiction, the types of treatment and the rehab process can vary in intensity and frequency. Types of treatment may include:7, 8

  • Medical detox: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable or even life-threatening. Medical detox helps you safely withdraw from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You may also be given medications to help minimize withdrawal symptoms.
  • Inpatient/residential treatment centers: Inpatient treatment involves living onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs. Medicaid may cover residential treatment depending on the length of the treatment program.
  • Partial hospitalization programs (PHPs): PHPs allow you to live at home while attending treatment during the day.
  • Intensive outpatient programs (IOPs): IOPs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and even go to work during the day.
  • Outpatient treatment: Individuals who have completed inpatient rehab treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

Many people wonder if inpatient rehab vs. outpatient rehab or another type of treatment is best for them. When you decide to get treatment for drug or alcohol addiction, you can work with your healthcare provider to determine the right continuum of care based on your needs and preferences.

Rehab Centers That Accept Medicaid

If you’re looking for a rehab center that accepts Medicaid, you have options. You can start by calling the number on the back of your insurance card and speaking with a representative. You can also call rehab centers to inquire about the types of insurance they accept.

Rehabs.com is a subsidiary of American Addiction Centers (AAC) with rehab centers across the U.S. You can use our directory to find treatment near you. Our directory makes it easy to filter your search by different criteria, including location and payment accepted.

Our facility, Desert Hope Treatment Center, is located in Las Vegas and accepts Medicaid for addiction rehabilitation services. This enables individuals with Medicaid coverage to access comprehensive addiction treatment, including detox, therapy, and aftercare.

Check Your Medicaid Rehab Coverage

If you’re struggling with substance use, it can be overwhelming to think about what treatment option is best for you. Knowing exactly what is covered can give you peace of mind so you can focus on recovery. To find out exactly what your insurance covers, you can call the number on the back of your insurance card, verify your insurance online, or fill out the form below.

What Should I Do if Medicaid Won't Cover the Total Cost of Rehab?

There are several rehab payment options to consider to help you pay the cost of treatment including include:

  • Payment plans: You pay off rehab in affordable installments.
  • Sliding scale: The rehab center decreases your cost to something you can reasonably afford—typically based on your income level.
  • Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehab facilities, offer grants and scholarships to pay for people who can’t afford substance abuse treatment.
  • Purchase affordable insurance on the Healthcare Marketplace.
  • Open a healthcare credit card or take out a specialized healthcare loan.
  • Use your savings or a credit card.

You can learn more about addiction treatment or the rehab admissions process by contacting American Addiction Centers 24 hours a day at .

 

Sources

  1. Medicaid.gov. (n.d.) Benefits.
  2. Medicare.gov. (n.d.) Medicaid.
  3. Medicaid.gov. (n.d.) Eligibility.
  4. Medicaid.gov. (n.d.) Behavioral Health Services.
  5. U.S. Department of Health & Human Services. (2021). Mental Health and Substance Use Insurance Help.
  6. Centers for Medicare and Medicaid Services. (2018.) Medicare and Medicaid Basics.
  7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  8. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
  9. American Council on Aging. (2022). Medicaid By State: Alternative Names and Contact Information.
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