Inpatient Drug And Alcohol Rehab Centers That Accept Medicaid
For eligible individuals, Medicaid insurance plans can provide coverage for drug and alcohol addiction treatment. The amount of coverage varies by the plan, and eligibility for Medicaid varies by state requirement.
Medicaid is a state- and federally-funded health insurance program that provides healthcare coverage for individuals who qualify. Finding treatment facilities that accept your Medicaid insurance plan can ease the process of selecting and paying for a program.
Does Medicaid Cover Alcohol And Drug Rehab?
Medicaid is an insurance coverage program for low-income individuals. Because the program is state-funded and state-run, the program has very specific guidelines for what will be covered for behavioral health services. These will vary by state and by patient need.
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) began a new standard of health coverage. It requires that all individual and group insurance health plans provide coverage for addiction treatment to the same degree they would cover other health issues.
Addiction Treatment Services Covered By Medicaid
Those who qualify for Medicaid generally do not have a copay for treatment services. For those who do have copays, there is a set out-of-pocket maximum they will be expected to pay. Copay amounts vary by state.
While Medicaid provides coverage for addiction treatment services for individuals who need it, those receiving treatment may have to complete a clinical assessment to prove medical need.
The following are treatment services covered by Medicaid:
- dual diagnosis treatment
- drug testing
- family counseling
- mental health treatment
Common Addiction Treatment Programs Covered By Medicaid
In addition, Medicaid covers major alcohol and drug addiction treatment needs, including inpatient rehab programs, outpatient services, mental health services, and medication-assisted treatment.
Coverage may depend on verified medical needs and may be limited to care within a certain, eligible rehab center.
If you want to use Medicaid to seek treatment for a substance use disorder, it may be worthwhile to know if your plan covers the following major treatment methods.
Inpatient (Residential) Drug And Alcohol Treatment
Inpatient rehab programs may be covered by Medicaid, but the amount of coverage and eligible rehab centers will vary by state. Within inpatient treatment (also called residential treatment), individuals stay onsite at the rehab facility for a number of days or weeks until treatment is completed.
Participants in inpatient rehab programs may take part in a number of therapies, counseling, detoxification, medication-assisted treatment, and more.
Often, Medicaid coverage for inpatient addiction treatment will depend on which rehab center a person chooses to attend. Some private rehab facilities will not accept Medicaid, but many do.
State-funded rehab centers typically accept Medicaid to provide free or low-cost addiction treatment to those in need. However, these facilities may have long waiting lists, so it’s best to research these treatment centers prior to seeking treatment.
Length of stay for an inpatient program covered by Medicaid may be very specific, such as 28 or 30 days. Longer stays may be approved according to patient need. Speaking to a treatment specialist to determine the exact amount of residential treatment stay covered by Medicaid can help avoid any surprise or excess fees or costs during treatment.
Outpatient Treatment Programs (IOP)
Some Medicaid plans may require those heading to substance abuse treatment for the first time to try outpatient treatment first.
Outpatient treatment is facilitated at a rehab center, doctor’s office, or hospital and offers some of the same methods as inpatient treatment but on a less intensive scale. Participants generally attend outpatient programs a number of days per week for two to three hours at a time.
Medicaid plans may provide coverage for a number of outpatient services, such as counseling, therapy, support groups, and medication maintenance programs with buprenorphine (Suboxone) or methadone. As with other services, the amount of coverage and eligibility requirements vary by each state’s Medicaid plan.
Certain outpatient programs may be covered at a higher rate than others. For instance, intensive outpatient programs (IOP) and partial hospitalization programs (PHP) provide a form of treatment similar in intensity to inpatient but at a greatly reduced cost. This increases the chances of Medicaid coverage for these programs.
Medication-Assisted Treatment (MAT)
Many individuals in addiction treatment need some form of medication to help alleviate cravings and other withdrawal symptoms and help keep them dedicated during the early stages of recovery. This form of treatment is known as medication-assisted treatment (MAT).
Medicaid coverage for medication-assisted treatment also varies by state plan, as some plans may not cover it at all, while others may cover it for a time with strict guidelines.
For example, some state Medicaid plans only cover daily doses of methadone after an individual has been treated with methadone for at least 30 days.
Using Your Medicaid Plan To Cover Addiction Treatment
If you want to use your Medicaid plan to cover treatment for drug or alcohol addiction, it’s important to consider some key factors.
First, make sure you choose a rehab center that accepts Medicaid. Not all treatment centers will comply with Medicaid coverage, and it’s best to know before heading to rehab if the rehab center you’re considering accepts your plan.
Talk first with a treatment specialist or your Medicaid provider to ensure you have everything in place before heading to treatment. This can include getting an assessment from a primary care provider (PCP) or getting the necessary paperwork in order.
Whatever is needed, it is helpful to have all factors in place before beginning treatment. Figuring out how to pay for addiction treatment using Medicaid will provide some financial relief and ease some of the concern associated with entering treatment.
Questions To Ask Before Using Medicaid To Pay For Rehab
Entering substance abuse treatment can be the best decision you make for your life and your recovery. But, it can also come with some understandable concerns.
One of the biggest factors that keep people from entering an alcohol and drug treatment program is cost. If you use your Medicaid plan to pay for treatment, you can alleviate most or all of these costs.
However, there are some questions you should prepare to ask of a treatment specialist, care provider, or insurance provider prior to treatment start.
This way, you will have no hidden costs or fees, will know exactly what you’re expected to pay, and can have the financial burden of paying for addiction treatment lifted.
Questions to ask when using your Medicaid plan to pay for rehab include:
- Does my Medicaid plan cover inpatient drug rehab? If so, what length of stay is covered?
- Does my Medicaid plan cover drug and alcohol detox? If so, is medication also covered?
- Does my plan cover medication-assisted treatment or medication maintenance?
- For continued care, does my Medicaid plan cover outpatient services? Which types?
- What is my responsibility: what are my copays, premiums, or deductibles, if any?
- Do I need to complete a clinical assessment to prove medical necessity?
- What paperwork do I need to send to my Medicaid provider prior to going to rehab?
Medicaid Eligibility Requirements
Medicaid has very specific eligibility requirements.
In general, Medicaid is available to individuals who are below a certain income level who are also:
- pregnant women
- youth or adolescent under 19 years of age
- senior age 65 or older
While most states require individuals receiving Medicaid to be both low-income and to meet one of the above requirements, some states provide Medicaid coverage to all individuals who meet income requirements.
To be considered low-income, an individual’s total household income must be below the federal poverty level (FPL) as determined by the Affordable Care Act. However, an individual may still be eligible to receive Medicaid above the federal poverty level if they fall within a certain income bracket.
To know for sure if you qualify for Medicaid coverage, speak to a treatment specialist or state Medicaid provider about eligibility requirements in your state.
Medicaid Plans By State
Medicaid is both federally and state-funded, so each state has its own guidelines for Medicaid coverage. While the insurance plan is nationally known as Medicaid, some states have alternative names for it.
The following is a list of Medicaid insurance plans by state:
- Alabama: Medicaid
- Alaska: DenaliCare
- Arizona: Arizona Health Care Cost Containment System (AHCCCS)
- Arkansas: Medicaid
- California: Medi-Cal
- Colorado: Health First Colorado
- Connecticut: HUSKY Health
- Delaware: Diamond State Health Plan
- Florida: Statewide Medicaid Managed Care Program
- Georgia: Medicaid
- Hawaii: Med-QUEST
- Idaho: Medicaid
- Illinois: Medical Assistance Program
- Indiana: Hoosier Healthwise; Hoosier Care Connect; M.E.D. Works; Healthy Indiana Plan (HIP); Traditional Medicaid
- Iowa: IA Health Link
- Kansas: KanCare
- Kentucky: Medicaid
- Louisiana: Healthy Louisiana (previously Bayou Health)
- Maine: MaineCare
- Maryland: Medical Assistance
- Massachusetts: MassHealth
- Michigan: Medical Assistance (MA)
- Minnesota: Medical Assistance (MA); MinnesotaCare
- Mississippi: Mississippi Coordinated Access Network (MississippiCAN)
- Missouri: MO HealthNet
- Montana: Medicaid
- Nebraska: Heritage Health
- Nevada: Medicaid
- New Hampshire: Medical Assistance
- New Jersey: NJ FamilyCare
- New Mexico: Centennial Care
- New York: Medicaid Managed Care
- North Carolina: NC Medicaid
- North Dakota: Medicaid
- Ohio: Medicaid
- Oklahoma: SoonerCare
- Oregon: Oregon Health Plan
- Pennsylvania: Medical Assistance (MA)
- Rhode Island: Medicaid; Medical Assistance (MA)
- South Carolina: Healthy Connections
- South Dakota: Medicaid
- Tennessee: TennCare
- Texas: Medicaid
- Utah: Medicaid
- Vermont: Green Mountain Care
- Virginia: Medicaid
- Washington: Apple Health
- Washington D.C.: Medicaid; DC Healthy Families (Health Care Alliance)
- West Virginia: Medicaid
- Wisconsin: ForwardHealth; BadgerCare
- Wyoming: Equality Care
Finding A Rehab Center That Accepts Medicaid
Using insurance to pay for alcohol or drug addiction treatment may feel confusing and frustrating, but it doesn’t have to be a complex process. Insurance can help reduce or eliminate the cost of addiction treatment, alleviating one of the biggest concerns most individuals have about entering recovery.
If you or a loved one are considering entering addiction treatment and you’re worried about cost, do not let this worry keep you from beginning your new sober phase of life. Contact a treatment specialist today to learn more about rehab centers that accept Medicaid and your treatment options.
Updated on September 23, 2020
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- CMS.gov — The Mental Health Parity and Addiction Equity Act (MHPAEA)
- Healthcare.gov — Medicaid And CHIP Coverage
- Medicaid.gov — Behavioral Health Services
- National Institute On Drug Abuse — Is Drug Addiction Treatment Worth Its Cost?
- Department of Health and Human Services—Category: Medicare and Medicaid
- Substance Abuse and Mental Health Services Administration (SAMHSA)—Medicaid Coverage of Medication-Assisted Treatment for Alcohol and Opioid Use DIsorders...