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Medicaid Insurance Coverage for Drug and Alcohol Rehab

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. In most cases, you must qualify for Medicaid based on Modified Adjusted Gross Income (MAGI).3 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 Medicare and Medicaid, Medicare pays first, and Medicaid pays second if the services are not covered.4 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 & 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.

Medicaid covers addiction treatment, but the amount of coverage depends on where you live and your coverage qualifications. This article discusses the types of Medicaid coverage and how they can help you get the care you need for substance use disorder (SUD). We also give you information about how to access your Medicaid benefits when you’re ready to take the first step on your path toward recovery.

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

American Addiction Centers (AAC) strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.

Does Medicaid Cover Addiction Treatment?

Medicaid typically pays at least some part of drug and alcohol rehab treatment. State insurance does typically cover rehab for most individuals. While Medicaid does often cover substance abuse 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 substance abuse and addiction 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- 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.2 Coverage may include:

  • Detox
  • Intervention
  • 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.

Different Types of Medicaid Substance Abuse Treatment

With most Medicaid plans covering at least some of the costs of rehab treatment for drug and alcohol addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:6,7

Detox Programs Near Me

In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, painful, or even life threatening. Medical detox helps you safely withdrawal from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You might also be given medications to help minimize withdrawal symptoms.

Residential Care or Inpatient Treatment Centers

Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs.

Partial Hospitalization Programs (PHP)

Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.

Intensive Outpatient Program (IOP)

Intensive outpatient programs 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 Facilities 

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.

When you decide to get treatment for a drug or alcohol addiction, you will need to decide what type of treatment is best for you.

How to Check Your Medicaid Rehab Coverage

Before choosing the right addiction treatment center for you, check your Medicaid policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your health insurance card or log in to your account on Medicaid’s website to learn more about what your specific policy plan covers.

Knowing exactly what your Medicaid plan covers can give you peace of mind while you or your loved one is in drug and alcohol rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles.

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Insurance Providers and Rehab Treatment Coverage Levels

More resources about Medicaid Insurance Coverage for Drug and Alcohol Rehab: