Medicaid Insurance Coverage for Rehab

Medicaid is a federal and state-funded health insurance program. The Department of Health and Human Services oversees the Medicaid program, but each state determines eligible treatment services within its borders.

Those adults who meet the eligibility requirements as low-income individuals or households may receive health coverage. Children, elderly adults, adults with disabilities, and pregnant women may be covered.

Medicaid is sometimes confused with Medicare, which is another health coverage program available through the federal government. Medicare covers adults over the age of 65, some individuals with disabilities, and those with End-Stage Renal Disease (ESRD).

Keep reading to learn whether you qualify for Medicaid services, what health plans are available, and what is covered for drug abuse treatment.

Yes, Medicaid insurance covers drug rehab. The Affordable Care Act (ACA), passed in 2008, has guided insurance coverage and restrictions since then.

Laws like the ACA and, most recently, the Mental Health Parity and Addiction Equity Act (MHPAEA) have given Americans better access to addiction treatment services and coverage for more levels of care.

The ACA determines 10 essential benefits that insurance policies must cover. Where you live and your plan will factor into your coverage options.

These are some of the benefits that may apply directly to drug abuse treatment:

• Outpatient care
• ER visits
• Mental health and substance use disorder treatment
• Prescription drugs
• Rehabilitation services
• Labs
• Chronic disease management

Because of the ACA, Medicaid coverage for addiction treatment is required to match coverage for treatment of other illnesses and surgery.

Inpatient treatment or partial hospitalization may be used for medical detox, which allows the body to withdraw from a substance while minimizing withdrawal symptoms.

Medication-assisted treatment (MAT) also helps with withdrawal symptoms.

It’s used to help a person recovering from addiction learn how to function again without the devastating side effects of drug use.

Often more intensive and allowing medical staff to monitor symptoms and vitals, inpatient rehab also helps ensure that a patient avoids relapse.

Especially in situations of recovery from severe addiction or in situations where one’s environment would be detrimental to recovery, inpatient rehab may be the better option.

An inpatient program helps not only in the short term, but teaches a person coping skills and stress management to allow them to foster lasting recovery.

If you’re working through treatment for substance use disorder (SUD), you may also be diagnosed with a mental health issue.

It’s very common for those who use drugs or alcohol to also need mental health services. A dual diagnosis program, or program for co-occurring disorders, will help you get on the path to the best possible treatment for your specific needs.

Outpatient treatment programs for drug rehab can be a range. You may need inpatient rehab followed by outpatient rehab.

You may be able to start with outpatient care as long as it’s an intensive outpatient program. Regardless, you’ll want to review your Medicaid coverage to understand which options in your area are available under your plan.

Drug rehab treatment usually includes some sort of counseling or behavioral therapy. This can be individually done or as part of a support group or group therapy.

It’s best to address both the physical substance use and the mental and environmental factors that contributed to the lifestyle choices that led to your addiction.

Behavioral health services like therapy help you explore those root causes and develop solutions moving forward.

Treatment for drug addiction should extend beyond rehab.

One of the ACA initiatives for Medicaid provides Community-Based Long-Term Care Services and Support. These support services can help you receive care close to home.

They may also provide care programs that include residential treatment as part of your recovery support.

So many factors can contribute to whether something is covered by Medicaid. Check with your specific plan to know what treatment options are available to you or your loved one.

The state you live in and your household income will be two of the biggest factors. You should also know that while some benefits are required under federal law, others are optional.

Optional coverage is determined at the state level, which means that if you move from a state where your treatment was covered to a state that doesn’t offer that same coverage, you’ll need to rethink your treatment plan.

No, Medicaid does not usually cover rehab programs outside of its network. You must verify a rehab program’s inclusion before you begin treatment.

You may need pre-approval or to pay costs out of pocket.

You should work with your treatment provider and Medicaid case management staff to determine if a treatment facility is covered under your plan.

Medicaid healthcare plans will differ based on your state, age, household members, and income level.

Standard Medicaid coverage applies mainly to low-income individuals, with benefits also available to adults who are older or have disabilities, children, and pregnant women.

The Basic Health Program may cover individuals whose income varies. While they may sometimes be able to afford private insurance, they may also have years where they qualify as beneficiaries for Medicaid.

The Children’s Health Insurance Program (CHIP) may cover children ages 19 and under if their parents don’t meet the eligibility requirements for low-income ranges in their state but can’t afford to pay for private health insurance.

Dual Eligible Special Needs Plans (D-SNPs) provide coverage for those whose eligibility meets the requirements for coverage under Medicaid and Medicare.

Because addiction is a chronic disease no matter what substance you’re addicted to, Medicaid covers treatment for addiction the same as it would treatment for standard physical ailments or surgical procedures.

This means if treatment is offered for an addiction, you should be able to get coverage for it with a Medicaid provider.

What would make the difference would be your Medicaid plan, location, treatment facility, healthcare provider, etc., rather than the substance to which you’re addicted.

To locate the nearest Medicaid-approved rehab centers near you, you can visit their official website or call their phone number.

You can also look at our list of addiction treatment centers for each state.

If you’re struggling to locate rehab centers that accept Medicaid in your area, you can contact our helpline for assistance.

We provide a comprehensive list of rehab facilities in each state, with a strict set of criteria for vetting facilities and can help match you with the right rehab center for you.