Addiction affects millions of people throughout the U.S. In Tennessee alone where the population is nearly 7 million, the drug overdose mortality rate is around 46 per 100,000.2 This puts Tennessee in the top 5 drug overdose states behind Delaware, Kentucky, Ohio, and West Virginia.3
Between 2017–2019, approximately 6.5% of Tennessee residents (367,000) reported a past-year substance use disorder (SUD).4 During that same timeframe in the state: 4
- 4.3% (246,000) reported a past-year alcohol use disorder.
- 0.9% (50,000) reported a past-year opioid use disorder.
- 2.8% (157,000) reported a past-year illicit use disorder.
If you’re struggling with addiction in Tennessee, you’re not alone. The good news is, you may be able to use your TennCare plan to cover at least some of detox treatment, inpatient or outpatient care, and more long-term residential treatment programs.
What Is TennCare?
Medicaid programs are federally- and state-funded and designed to provide healthcare coverage to millions of people including those with disabilities, elderly adults, low-income families, and pregnant women.5 As of September 2021, approximately 78 million people across the country were covered by a Medicaid program.5
TennCare is the state of Tennessee’s Medicaid program, which went into effect on January 1, 1994. Since then, TennCare has become one of the oldest Medicaid managed care programs in the U.S.6 Approximately 1.5 million Tennessee residents are covered by TennCare, which equates to approximately 20% of the state’s total population.6
There are different types of TennCare benefit packages, which provide varying levels of coverage for healthcare services.7 The benefits that are covered depend on the type of plan that you have. To learn more about what your specific TennCare plan covers, call TennCare Connect at 855-259-0701 or review your plan’s handbook.7 If you have further questions, you can also call your health plan at the number on the back of your card.
Who Is Eligible for TennCare?
To be able to enroll in TennCare, you must meet the eligibility standards for TennCare Medicaid.8 Groups that may qualify for coverage under TennCare Medicaid, include:8
- Children under the age of 21.
- Parents or caretakers of minors that are relatives and live with you.
- Pregnant women.
- Those who need breast or cervical cancer treatment.
- Those who receive a supplemental security income (SSI) check.
- Those who have received an SSI check and Social Security check in the same month at least 1 time since April 1977 and continue to receive a Social Security check.
- Those who live in a medical institution and have an income below $2,382/month or receive other long-term care services that are paid for by TennCare.
Eligibility for these groups depends on income and resource limits, which are adjusted annually. Each group has different eligibility income and resource limits, so it’s important to check limits carefully. For assistance, contact TennCare Connect.
Does TennCare Cover Drug and Alcohol Rehab Treatment?
Yes, under the Affordable Care Act (ACA), Medicaid programs, including TennCare, must provide some level of coverage for mental and behavioral health services, as they are 1 of the 10 essential health benefits (EHBs).9
Specifically, TennCare plans must cover the cost of treatment for substance use disorder (SUD), including drug and alcohol rehab treatment in some capacity in Tennessee and out of state.9 Keep in mind that coverage details vary depending on your specific TennCare plan and the facility in which you seek treatment. As such, it’s important to call the number on the back of your insurance card to confirm coverage before entering treatment.
How to Find a Facility Near You
If you’re looking for a facility near you, you have options. There are many rehab centers in Tennessee you can consider that may accept TennCare or offer financing options for treatment.
You can use the American Addiction Centers (AAC) directory to begin your search. Filter by location, payment options, and services offered. If you don’t see a facility near you, you can consider traveling out of state. AAC has facilities throughout the U.S., including Oxford Treatment Center in Mississippi, a few hours from Tennessee.
Do Rehabs Need to Be In-Network to Accept TennCare?
A network refers to the facilities, providers, and suppliers that are contracted by your insurer to provide you with covered health services.10 If you want to use your TennCare plan to cover at least some of the cost of rehab, you should find an in-network provider.
TennCare enrollee access to out-of-network providers is generally limited for circumstances in which an in-network provider was not able to provide the needed care, subject to prior authorization.11
What Types of Addiction Treatment Does TennCare Cover?
The types of addiction treatment your TennCare plan will cover vary based on the type of plan you have. Still, common addiction treatment programs that may be covered in some capacity under your TennCare plan include:12, 13, 14
- Detox programs: While not all patients need detox (the process in which the body rids itself of substances such as drugs and alcohol), for some, it’s an important first step in their recovery. In medically-managed programs, patients can comfortably and safely detox while under the care of medical professionals. This is typically done in a medical setting to help manage the side effects of withdrawal.
- Residential inpatient programs: These programs offer intensive therapy for substance use disorders (SUDs). They vary depending on the facility and the length of your stay but often include 24-hour structured care, medical attention when necessary, and a combination of group and individual therapy.
- Outpatient programs: These programs vary in the intensity and types of services offered, but many emphasize group counseling. With this type of program, patients live at home and attend treatment during the day.
- Intensive outpatient programs (IOP): Some outpatient programs are more structured and are referred to as an IOP. This type of program can be similar to a residential program and may include several of the same services. Patients typically attend a minimum number of hours of outpatient sessions each week.
- Partial hospitalization programs (PHP): PHPs offer a high level of care during the day but allow patients to return home in the evening. This can sometimes be a “step-up” from outpatient or a “step down” from inpatient.
- Aftercare programs: The term aftercare (sometimes referred to as continuing care or follow-up care) is used to refer to any type of care that’s administered after rehab is completed. These programs vary in length and services provided, but all have the same goal: to maintain recovery, prevent relapse, and achieve a fulfilling life.
Does TennCare Cover Mental Health & Dual Diagnosis Treatment?
Yes, under the Affordable Care Act (ACA), your TennCare plan should provide some level of coverage for mental health and dual diagnosis treatment.9
Dual diagnosis, which is also referred to as a co-occurring disorder, is when someone experiences both a mental health and substance use disorder (SUD) at the same time. Dual diagnosis is common with approximately 17 million adults in the U.S. experiencing a dual diagnosis in 2020.15 Researchers believe that about half of those who are diagnosed with SUD will experience a mental health disorder at some point in their life and vice versa.16
Common mental health disorders that may co-occur with SUD include:17
- Attention deficit hyperactivity disorder (ADHD).
- Bipolar disorder.
- Post-traumatic stress disorder (PTSD).
- Mood disorders.
For those with a co-occurring disorder, integrated intervention is often the recommended course of treatment, in which both conditions are treated at the same time.15
How Much of the Rehab Cost Does TennCare Cover?
The extent of rehab costs covered by your TennCare plan varies depending on your plan. For more information about your coverage, it’s best to call the number on the back of your insurance card and speak with a TennCare representative.
Coverage will also vary depending on the length of treatment. Recovery looks different for everyone, and patients progress through treatment at different rates. However, research suggests that adequate treatment length is associated with better outcomes.18 There is no standard length of treatment, so be sure to talk to your provider about realistic timelines for your situation. Recovery is possible so don’t let the duration of treatment or the cost of treatment keep you from getting the care you deserve and need today.
What if TennCare Doesn’t Cover the Cost of Rehab?
Your TennCare plan may not cover all or part of your rehab costs. If this is the case, don’t worry. There are lots of ways to pay for treatment. Many facilities offer financing options for those who need them. You can ask the rehab you are considering whether grants, scholarships, or sliding scale payment options are available to you. Ultimately, getting the care you need is the most important thing.
Getting Help for Addiction
If you’re ready to take the first step in your recovery, it’s time to contact a treatment provider and set up a screening.19 Here, it will be determined whether you’re eligible to receive Substance Abuse Prevention and Treatment (SAPT) Block Grant services. If so, the provider will arrange another assessment to determine the severity of substance use disorder (SUD) and an appropriate level of care or treatment program.19 From there, you’ll be admitted into a program or referred to another provider.19
To learn more about your treatment options, contact an admissions navigator at American Addiction Centers (AAC) today. AAC is committed to providing compassionate, high-quality healthcare for those suffering from the disease of addiction and co-occurring psychiatric disorders. Contact us today at to learn how we can help.
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- Division of TennCare. (n.d.). TennCare Medicaid.
- United States Census Bureau. (2021). QuickFacts Tennessee.
- Centers for Disease Control and Prevention. (2022). Drug overdose mortality by state.
- Substance Abuse and Mental Health Services Administration. (2020). Behavioral health barometer: Tennessee, volume 6.
- Medicaid.gov. (n.d.). Medicaid.
- Division of TennCare. (n.d.). TennCare overview.
- Division of TennCare. (n.d.). Covered services.
- Division of TennCare. (n.d.). Eligibility.
- Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
- Healthcare.gov. (n.d.). Network.
- Tennessee Department of Finance & Administration. (2019). Mental health parity in the TennCare and CoverKids programs.
- National Institute on Drug Abuse. (2020). Types of treatment programs.
- National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction DrugFacts.
- Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment?
- National Alliance on Mental Illness. (2020). Substance use disorders.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders research report.
- Substance Abuse and Mental Health Services Administration. (2021). Co-occurring disorders and other health conditions.
- National Institute on Drug Abuse. (2020). How long does drug addiction treatment usually last?
- Department of Mental Health & Substance Abuse Services. (2021). SAPT block grant treatment providers and services.