Introduction to Medicaid
Medicaid operates at a state level, so it’s not always subject to the federal rules—which means some states’ Medicaid agencies chose to deny coverage for medication-assisted treatment until recently. That’s not the case anymore—at the end of 2020, the Department of Health mandated that Medicaid must cover medication-assisted treatment through an opioid treatment program.
What does that mean for you when you’re on the hunt for rehab health insurance coverage? It means that your Medicaid plan almost certainly includes some coverage for addiction treatment, but how much varies depending on your state and plan. And it can vary a lot, so it’s important to check with your state Medicaid office.
Chances are that if you’re here, you’re a Medicaid enrollee. Most people who use government-funded health insurance plans use Medicaid. Medicare covers around 12 million people, but there are over 76 million people enrolled in Medicaid across the entire country.
What is Medicaid?
Medicaid is a public health insurance program that provides services to people in need of assistance paying for premiums and other healthcare costs. Medicare and Medicaid programs are more different than they are similar (except for the details of their rehab coverage).
Who Qualifies for Medicaid State-Based Health Insurance?
Medicaid is a state government healthcare plan that provides low-cost or no-cost insurance to people who need help paying for it, including:
- People who earn less than the income limit, which varies from state-to-state and based on your household size and whether you have children
- People who have a qualifying disability
- People who receive SSDI payments, or Supplemental Security Income
- Emancipated teens who live without their parents
- Pregnant people and children
The requirements for Medicaid eligibility are different in each state. If you’re interested in getting Medicaid rehab coverage, you can find your state’s details by going to Medicaid.gov.
Can You Have Both Medicaid & Medicare?
Some people qualify for both Medicare and Medicaid, even though it’s uncommon. You’re most likely to have both Medicare and Medicaid if you qualify for Medicaid and turn 65, which qualifies you for Medicare too.
When you have Medicare and Medicaid at the same time, it’s called dual eligibility. When you’re dually eligible, Medicare usually pays for healthcare costs first, and Medicaid pays for any covered costs that remain.
Medicaid for Alcohol and Drug Rehab
If drug or alcohol treatment are in your future, you’re most likely wondering how that works in terms of Medicaid rehab coverage. The specific details of Medicaid drug rehab coverage are very different from state to state, so it’s impossible to predict what the process and cost may be.
You should always double-check your Medicaid rehab insurance coverage before making decisions about where to get addiction treatment or which rehab program to enter.
How to Check Medicaid Coverage
There’s no single Medicaid office you can call because it’s a state-run program, so there are 51 different phone numbers!
The Medicaid website at Medicaid.gov can direct you to your state’s Medicaid office phone number and extension so you can contact them to answer your questions about what’s covered.
Are you already enrolled in Medicaid? Your state’s Medicaid office has their phone number on your insurance card.
Medicaid Health Insurance Eligibility
If you’re not already enrolled in Medicaid and you want to be, you can check your eligibility on your state’s Medicaid website—either by checking the listed requirements or by calling the listed phone number.
In general, most states have Medicaid eligibility requirements that include:
- People who earn under a certain income threshold
- People who have a disability or medical condition that qualifies, which varies from state to state
- Pregnant people and children
- Emancipated teens or foster teens
Again, this is only a general list of what the Medicaid requirements might look like in some states. To find your state’s requirements, go to Medicaid.gov.
What is the Average Cost of Rehab with Medicaid?
If you qualify for Medicaid or you already have it, you may be wondering about the average cost after Medicaid rehab coverage.
It’s hard to eyeball the potential cost of rehab with Medicaid. Between two policies, treatment centers, or Medicaid state programs, the cost of any healthcare can vary by hundreds or thousands of dollars!
Still, you can gather some information to get an idea of whether rehab coverage is part of your plan.
The cost of rehab after any kind of insurance coverage depends on:
- Whether the treatment center is an approved facility by Medicaid
- Whether the treatment program is approved by Medicaid
- The specific coverage available on your plan and policy
- The listed cost of the treatment center and program that you attend
- Your coinsurance, or the set percentage of the treatment cost that Medicaid asks you to cover
- Your copay, or a set amount of money that you pay when you receive treatment
- Your deductible, or the amount of healthcare (including rehab) that you have to cover before coverage kicks in
If you already know where you want to attend rehab or what program, you can look into all the above information and get a broad guess of the cost. Alternately, take the easy route and call your state Medicaid office to confirm the costs that you’re responsible for covering.
What is the Average Cost of Rehab With Medicaid Supplemental Insurance?
Supplemental insurance plans don’t typically cover rehab whether they’re Medicaid or not, since they’re considered short-term plans and not operating under the Affordable Care Act. If you go to rehab with a supplemental plan of any kind, you’ll be responsible for the cost out of pocket.
What Does Medicaid Cover?
Medicaid covers medically necessary treatment for pre-existing conditions, but Medicaid plans have different coverage from state to state.
You can’t predict what exactly your Medicaid rehab coverage looks like until you check it. The differences between state programs are simply too big! Instead, you can:
- Ask your treatment center to check your coverage and let you know if you’re covered (and if they accept your insurance)
- Check your Medicaid insurance card and call the phone number for your state’s Medicaid office
- Go to Medicaid.gov to find your state’s program details
Does Medicaid Cover Alcohol or Drug Rehab?
Long-term Medicaid plans cover alcohol and drug rehab at least to some extent. The exact substance abuse treatment coverage is very dependent on your state’s Medicaid program, so you’ll have to give the office a call to confirm your own.
However, Medicaid covers all medically necessary treatment for pre-existing conditions, including substance use disorders.
If you have a substance use disorder, talk to your family doctor about your concern. They’ll be able to provide a referral and help you with prior authorization, which helps Medicaid decide that rehab is medically necessary. They’ll also know about programs that work with Medicaid and can refer you.
That being said, there are a few types of rehab programs that Medicaid usually approves (but check with your state).
Does Medicaid Cover Detox Programs?
Most Medicaid programs consider detox to be medically necessary, which means they’re likely to offer detox insurance coverage.
Detox treatment programs are often covered because the withdrawal process can be so difficult with some drugs. In particular, it can be dangerous to your health to stop using alcohol or some prescription drugs (benzodiazepines) without medical help. For other drugs, like heroin, withdrawal isn’t a medical emergency but it can lead to relapse.
Does Medicaid Cover Residential Inpatient Programs?
Medicaid rehab coverage usually includes residential inpatient rehab programs as long as they’re medically necessary.
The actual inpatient rehab insurance coverage you get can range from partial to full, and it depends on the treatment center and program being approved and accepting Medicaid.
The services that Medicaid might approve include:
- A residential stay: Medicaid might approve your stay for several weeks depending on your medical need.
- Behavioral treatment: Covered residential programs include behavioral treatment, which is the cornerstone of successful recovery.
- Counseling: Medicaid often covers counseling services as part of residential treatment to help patients cope with the change.
- Medication-assisted treatment: If you previously used alcohol or opioid drugs, Medicaid may cover medications to control your substance use disorder.
You may need to talk to your family doctor about a referral and prior authorization to ensure Medicaid covers your residential treatment. If that’s necessary, your state’s Medicaid office can let you know, but in most cases your doctor has access to your Medicaid coverage and can help you.
Find out the specifics of your Medicaid residential coverage by calling your family doctor, calling your treatment center, or going to Medicaid.gov.
Does Medicaid Cover Outpatient Programs?
Medicaid covers many outpatient programs that are medically necessary for addiction treatment. Your Medicaid outpatient coverage depends on your plan and policy, so your program could cover outpatient in part or in full.
The types of outpatient programs that Medicaid can cover include:
- Partial hospitalization: This type of outpatient treatment requires daily attendance and it’s sometimes covered for people with severe substance use disorder.
- Intensive outpatient: Intensive outpatient is another often-covered type of treatment that offers a high level of care to people who need it.
- Standard outpatient: If you’re relatively stable, your Medicaid program may cover standard outpatient, which can be very flexible depending on your needs.
Medicaid covers a range of outpatient services within those programs. They might include:
- Behavioral treatment
- Counseling services
- Lab work
- Medication costs
- Medication checks
You can get the details on what your Medicaid plan covers by checking Medicaid.gov, calling your treatment center, or calling your doctor.
Does Medicaid Cover Medication-Assisted Treatment Programs?
Sometimes Medicaid covers medication-assisted treatment programs that are standalone without a structured outpatient component. These are usually an option for people who are more stable in condition; sometimes you’ll need to attend inpatient or outpatient first.
Most of the time, Medicaid covers appointments, lab tests, and medications related to medication-assisted treatment.
To find out what your plan covers and what your medication-assisted treatment insurance coverage may be, check Medicaid.gov.
Does Medicaid Cover Mental Health and Substance Abuse?
Most Medicaid plans cover dual diagnosis treatment for mental health and substance use disorders. These disorders occur together very often and you can’t treat one without treating the other.
Medicaid may cover these dual diagnosis services:
- Residential dual diagnosis programs
- Outpatient dual diagnosis programs
- Behavioral treatment, including cognitive-behavioral therapy and dialectical behavior therapy
Dual diagnosis programs that are covered by Medicaid can be inpatient or outpatient, depending on what’s medically necessary for you.
Medicaid Plans By State
Because Medicaid isn’t a federal program, there are different Medicaid plans for every single state! While the fundamentals are the same (Medicaid must cover medically necessary treatment in some form), here’s what can vary by state:
- Which rehab programs are covered under Medicaid
- The amount of Medicaid rehab coverage you have
- Your deductible, the amount you have to spend out-of-pocket before receiving Medicaid benefits
- Your coinsurance, the percentage of treatment costs that you’re responsible for covering after Medicaid pays their portion
- Your copay, a set cost that you pay to enter treatment regardless of the details
Check with your state to get the specifics on local Medicaid coverage for drug rehab. These New England states are known for having robust Medicaid programs:
Connecticut Medicaid Addiction Treatment Coverage
HUSKY Health is the state-run health insurance program that offers assistance for those who need it in Connecticut. You can learn more about your HUSKY Health Connecticut rehab coverage by calling the HUSKY Health office at 1-877-CT-HUSKY between 8:30 am and 6 pm EST on weekdays.
Maine Medicaid Addiction Treatment Coverage
MaineCare is the state health insurance program in Maine for state residents with limited resources who need assistance. You can find out what treatment programs the MaineCare program covers by calling the Office of MaineCare Services at 207-287-3707.
Massachusetts Medicaid Addiction Treatment Coverage
MassHealth is the Medicaid program in Massachusetts for people who need help paying for healthcare in MA, including rehab treatment. Learn what addiction treatment options your MassHealth plan may cover by calling the MassHealth Customer Service Center at 800-841-2900 on weekdays between 8 am and 5 pm EST.
New Hampshire Medicaid Addiction Treatment Coverage
New Hampshire Medicaid is the state-funded healthcare program for people who meet eligibility requirements in NH. You can get the specifics of your NH Medicaid coverage for substance use treatment by calling the Office of Medicaid at 603-271-4344 between 8 am and 4:30 pm EST.
New Jersey Medicaid Addiction Treatment Coverage
NJ FamilyCare is the Medicaid program for residents of New Jersey who need assistance paying for medical treatment, such as rehab. You can get more information about NJ Medicaid addiction treatment coverage by calling the Health and Human Services office at 1–800-356-1561.
New York Medicaid Addiction Treatment Coverage
New York Medicaid and Family Health Plus are the Medicaid programs for people who live in NY and need assistance. You can reach the Health Department’s Growing Up Healthy hotline at 1-800-522-5006 to ask questions about your Medicaid drug rehab coverage.
Rhode Island Medicaid Addiction Treatment Coverage
In Rhode Island, HealthSource RI is the state-funded assistance program for healthcare coverage. You can call 855-840-4774 to reach the enrollment specialist team, who can answer your questions about drug rehab coverage.
Vermont Medicaid Addiction Treatment Coverage
VT Medicaid is the Vermont state-funded healthcare coverage program for people who qualify. You can reach the Vermont Medicaid office to talk about your addiction treatment coverage by calling 800-250-8427.
Learn About Addiction Treatment Coverage at Bedrock Recovery Center
Bedrock Recovery Center can help you figure out the insurance coverage part of the rehab journey so you can focus on what matters most.
Our admissions team is happy to walk you through the insurance types that we accept and reach out to your insurance company to verify your coverage. Your addiction treatment stay could begin tomorrow, so don’t wait! Give us a call to find out how Bedrock Recovery Center can change your life for good.