MassHealth Covered Substance Abuse Treatment Centers Near Me
Does MassHealth Insurance Cover Alcohol and Drug Rehab?
If you’re in Massachusetts and have a MassHealth plan, you may be wondering whether your coverage extends to alcohol and drug rehab. There are 6 MassHealth health plans, and depending on which you’re eligible to enroll in, you may be offered a handful of coverage options.1 If you’re looking for an alcohol and drug rehab center that accepts your MassHealth insurance plan or want to learn more about your existing coverage, you can call the number on the back of your insurance card.
What Is MassHealth?
MassHealth is a program that combines Medicaid and Children’s Health Insurance Program (CHIP).1 This Massachusetts program provides covered members with health benefits and helps qualified groups pay for them.2 Health benefits are directly offered to eligible members. MassHealth can also help pay health insurance premiums, giving its members access to dental care and prescription drugs as well as behavioral health and other healthcare services.2
Certain low– and medium-income qualifying families, children, seniors, and people with disabilities who live in the state of Massachusetts may be eligible for a MassHealth plan.2 To be considered eligible for a MassHealth plan, you need to live in the state of Massachusetts, have a financial situation that is classified as low or very low, and be a U.S. national, citizen, permanent resident, or a legal alien.3 If you believe you meet these requirements, you can apply for MassHealth online.
What Are MassHealth Coverage Levels and Plans?
Depending on the MassHealth health plan that you have, there may be differing levels of coverage. Some of the plans offered include Standard, CommonHealth, CarePlus, Family Assistance, Premium Assistance, and Limited.4 What sets each plan level apart are eligibility requirements and costs involved. Regardless of the MassHealth plan you have, you will typically receive the following basic plan benefits:5 “View basic plan details” button
- Outpatient services (access to dentists, family planning, vision care, doctors, clinics, and hospitals)
- Inpatient hospital services
- Inpatient mental health and addiction services
- Outpatient mental health and addiction services
- Medical tests and services
- Smoking cessation services
- Coordination of care
Even though a service may be listed above, you may need to receive prior authorization or a referral from your primary doctor for coverage. To check your specific coverage, review your MassHealth Member Handbook or call the number on the back of your insurance card.
Which States Do Masshealth Operate In?
MassHealth only operates in Massachusetts.2 You must live in the state of Massachusetts, which could include living in major cities like Boston, Salem, Cambridge, Worcester, or Lowell, and be a registered resident to be eligible to have a MassHealth plan. Eligibility for MassHealth plans will also be determined by your unique situation, which may include income requirements.
What Will MassHealth Insurance Cover?
What’s covered under your MassHealth insurance plan may vary. Other factors that contribute to your MassHealth insurance coverage include where you seek treatment and how long your treatment may last. Some of the following treatment methods may be covered under your MassHealth plan:
- Inpatient or residential rehab. In an inpatient or residential rehab program, you’ll get treatment at a facility, where you’ll remain for the duration of your stay. Care received within the rehab facility could include medical detox, therapy, or medication-assisted treatment (MAT).6, Pg. 8, “What types of treatment programs are available?” Para 2
- Outpatient rehab or therapy. In an outpatient rehab program, you go to a treatment facility once or twice a week to get the necessary care. Most outpatient programs involve getting therapy but do not involve an overnight stay.6, Pg. 10, Para 2
- Intensive outpatient programs (IOP). An IOP is a type of outpatient program that provides a more structured treatment path than the standard outpatient program. With an IOP, you will receive a minimum number of hours of treatment each week, but you don’t have to stay overnight at the facility.6, Pg. 10, Para 3
- Partial hospitalization programs (PHP). In a PHP, which is referred to often as a day program, you go to a facility multiple days a week. You’ll stay there for 4 hours to 8 hours per day and receive the care you need.6, Pg. 10, Para 1
Just because these are common treatment methods, that doesn’t mean that it is the right path for you. Be sure to work directly with your mental health provider to determine the right recovery path for you. Additionally, be sure to verify your benefits and coverage before seeking treatment.
Does MassHealth Insurance Cover Mental Health Treatment Facilities?
Under the Affordable Care Act, almost all U.S. health plans, including those by MassHealth, are required to provide some level of coverage for mental health care services.7 Specifically, all plans must provide coverage in some capacity for mental and behavioral health inpatient services, behavioral health treatment, and substance use disorder treatment.7
Although there are a variety of MassHealth insurance plans, all plans provide insurance coverage for inpatient and outpatient mental health and addiction services.5 This means that your MassHealth plan may provide coverage for co-occurring disorder treatment and stand-alone heroin rehab based on this mandate.
A co-occurring disorder is what it is called when someone has both a mental illness and substance use disorder.8 Co-occurring disorders are common, as 17 million U.S. adults have a co-occurring disorder or a dual diagnosis.8
While it’s not believed that a substance use disorder directly causes a mental illness or vice versa, those who have a SUD have a higher likelihood of developing a mental illness.9 “Does one cause the other?” Because these conditions can influence each other, integrated treatment (or treating the conditions in tandem) is often recommended.9 “What should I do?” In this type of treatment approach, you’d receive treatment for each condition concurrently to help address the 2 conditions.9 “What should I do?”
Plan coverage details typically vary, which is why you should verify your benefits before seeking care for stand-alone rehab or co-occurring disorder treatment.
How Long Does MassHealth Insurance Cover Rehab?
How long your MassHealth insurance plan will cover rehab costs will vary based on the plan you have. Additionally, the plan you have, where you seek care, and the intensity of treatment you need may also affect your coverage.
Regardless of the length of rehab covered under your plan, it’s important to prioritize remaining in treatment for an appropriate length of time. Staying in treatment for an adequate length of time is critical to the success of your recovery. Most programs should last at least 3 months to reduce or stop drug use and improve overall outcomes.10, bullet 5
What if My MassHealth Policy Does Not Cover Rehab?
Your MassHealth policy may not fully or partially cover the costs of rehab. If this is the case, you may be on the hook for paying the costs of rehab out-of-pocket. There may be payment options available to you, though, depending on the rehab center you choose to attend. Examples of these payment arrangements can include scholarships or financing opportunities. Be sure to ask the rehab center whether any of these options are available to you, as they can help offset some of the burdens of care.
Even though the upfront costs of rehab may seem steep, the long-term costs of continuing addiction and delaying care can become more burdensome. Prioritize getting treatment right now rather than pushing it down the road.
MassHealth In-Network vs. Out-of-Network Rehab Centers
A network refers to the group of hospitals, doctors, and other providers of health care services who are contracted by a health plan to give plan members medical care.11 MassHealth plans operate with networks. With a MassHealth plan, you will choose a health plan and a primary care provider (PCP).12 Your plan and provider will work together to coordinate your care.12 You typically must work with your PCP to get your care, including for drug and alcohol rehab.
Checking whether a treatment provider is in- or out-of-network is simple. You can call the number on the back of your insurance card or through your online portal. You can also work with the rehab center directly to check whether your insurance is accepted at the facility.
Check MassHealth Insurance Coverage for Rehab and Detox Centers
If you have a MassHealth insurance plan and are struggling with addiction, you may be wondering whether you can use your MassHealth coverage to cover your rehab costs. Determining what your coverage levels are and where your plan is accepted can be difficult, but American Addiction Centers (AAC) is here to help.
AAC is here to help you verify your insurance coverage for you. If you call the AAC helpline, you’ll speak to an admissions navigator who can walk you through rehab information, check your benefits, and find a nearby covered facility. You can also instantly check your benefits online by filling out the form below and see immediately if a provider is in your plan’s network.
- Mass.gov. (n.d.). MassHealth.
- Benefits.gov. (n.d.). Massachusetts MassHealth (Medicaid).
- Mass.gov. (n.d.). Eligibility for health care benefits for MassHealth, the Health Safety Net, and Children’s Medical Security Plan.
- Mass.gov. (n.d.). MassHealth coverage types for individuals and families including people with disabilities.
- MassHealthChoices. (n.d.). Compare plans.
- Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment? (Original work published 2004).
- HealthCare.gov. (n.d.). Mental health & substance abuse coverage.
- National Alliance on Mental Illness. (2020, May). Substance use disorders.
- National Alliance on Mental Illness. (2017, October 4). Understanding dual diagnosis.
- National Institute on Drug Abuse. (2018, January). Principles of effective treatment.
- MassHealthChoices. (n.d.). Words to know.
- MassHealthChoices. (n.d.). Learn.
- Insurance Provider Name
- Policy Member's Full Name
- Policy Membership/Subscriber ID