Does Medicaid Insurance Cover Alcohol and Drug Rehab?
Medicaid Insurance Coverage for Drug & Alcohol Addiction Treatment
Medicaid is a government-funded insurance program for low-income individuals. The state-funded, state-run program has specific guidelines for what behavioral health services—including drug and alcohol addiction treatment—are covered by Medicaid, and each state’s rules vary.
Nearly 12% of Medicaid beneficiaries over the age of 18 have a substance use disorder, and Medicaid does provide some coverage for drug and alcohol addiction rehab and treatment.1 The amount covered for treatment varies state to state and other by factors, including your income and whether or not there is a medical need for treatment.2
In order for Medicaid coverage to pay for rehab expenses, your primary care provider may need to assess you and complete the necessary paperwork before you begin treatment. If you have a rehab treatment facility in mind, ask them if they accept Medicaid insurance and what is required in order for Medicaid coverage to kick in to help offset the costs.
What Does Medicaid Cover?
Medicaid is the largest payer for substance use disorder treatment and recovery services in the United States.3 In fact, Medicaid covers 40% of all individuals with opioid use disorder, and even more in some states that have expanded access to Medicaid under the Affordable Care Act.3
All state Medicaid programs across the country provide some coverage for substance use disorder treatment. These services often include:4
- Initial screening.
- Medications for managing cravings and withdrawal.
- Family counseling.
- Inpatient rehab.
- Long-term residential treatment.
- Outpatient rehab.
- Other mental health services (e.g., therapy, counseling).
More detailed information about the types of addiction treatment services that may be covered by Medicaid is as follows:5
- Partial hospitalization (PHP): Partial hospitalization programs involve a commitment to attending treatment during the day while living at home. Most PHP programs last anywhere from 15-90 days.
- Intensive outpatient (IOP): Intensive outpatient programs involve attending treatment a few times a week. You can live at home and go to work during the day and must attend treatment in the evenings. IOP programs are a good choice for those who have work and family obligations that prevent them from participating in a more time-intensive treatment program.
- Inpatient treatment/residential rehab: Inpatient treatment/residential rehab involves living in a rehab facility for a certain number of days. Most inpatient treatment programs last anywhere from 15-90 days, depending on your needs. Inpatient treatment involves attending one-on-one counseling, group therapy, and 24/7 support from the rehab facility staff.
- Outpatient treatment: Outpatient programs allow you to live at home and attend treatment at a rehab facility or hospital. Depending on the program, you will attend treatment anywhere from 2-7 days per week.
Does Medicaid Cover Mental Health Treatment?
All state Medicaid programs across the country, no matter which state you are in, provide some coverage for mental health services and substance use disorder treatment. These services often include:6
- Medication management.
- Social work services.
- Peer supports.
Many people with substance use disorder also have other mental health conditions, including anxiety, depression, PTSD, and mood disorders. These are known as co-occurring disorders, and are sometimes referred to as “dual diagnoses.” According to the 2016 National Survey on Drug Use and Health, more than 8 million adults aged 18 or older with substance use disorder also had a co-occurring disorder.7
Treating co-occurring disorders at the same time substance use disorder is treated/addressed is important. These conditions can impact each other, so it is best to treat both at the same time.8
The Affordable Care Act lists substance use disorder as one of the 10 elements of essential health benefits that insurers must provide. As a result, Medicaid and other insurance providers are required to provide coverage for mental health care and treatment.9 Both rehab and mental health care services fall under this mandate.
The amount of treatment costs that Medicaid will cover varies from state to state. You can call Medicaid directly to inquire about what is covered in your state or contact the rehab center you are considering directly so they can check your benefits for you while you are on the phone.
How Long Does Medicaid Pay for Rehab?
The length of time Medicaid covers rehab varies. Generally, Medicaid has limits on the amount of covered services per year in categories of treatment. For example, inpatient treatment duration may be limited to a certain number of days per calendar year, though most treatment duration is based on individual patient needs.[10, p15]
Inpatient rehab programs typically last anywhere from 15-90 days, depending on an individual’s needs. Treatment duration is based on what the patient needs and not on what insurance covers.
You can look up the details of your own plan by calling the number on the back of your insurance card. Alternatively, you can contact the rehab center directly and they can check your Medicaid benefits for you while you are on the phone.
Who Is Eligible for Medicaid?
Medicaid is a government-funded public insurance program for low-income individuals and families. Medicaid covers some aspects of drug and alcohol dependency treatment. To be eligible for Medicaid, applicants must be one or more of the following:11
- Over 65 years old.
- Under 19 years old.
- A parent.
- Within a specified low-income bracket.
In some states, Medicaid covers all adults below a certain income level, even if you do not fit into one of the aforementioned categories. If you receive supplemental security income, you are typically eligible for Medicaid.
To determine if you are considered low-income, your total household income must be below the federal poverty level as determined by the Affordable Care Act. However, you may still be eligible to receive Medicaid even if you make more than the federal poverty level, depending on your income bracket.
To verify if you qualify for Medicaid coverage, speak to your state’s Medicaid office about eligibility requirements.
How to find Rehab Centers That Take Medicaid?
Finding a rehab treatment facility that is affordable can be an exercise in patience and frustration. Though it requires some work, the important thing to remember is that Medicaid can help you reduce or even eliminate the cost of drug and alcohol addiction treatment. This can bring comfort and peace of mind so you can focus on what truly matters—your sobriety and recovery. Don’t let the cost of rehab be a barrier to seeking treatment.
The Centers for Medicare and Medicaid Services (CMS) releases information on effective practices for treating substance abuse disorders. If you are looking for a rehab that accepts Medicaid for addiction treatment, consider these resources:
- Rehabs That Accept Medicaid for Substance Use Disorders
- Delivery Opportunities for Individuals with a Substance Use Disorder
- Finding Addiction Treatment
- Medicaid website
Some states may require that you pay copayments, coinsurance, and deductibles on inpatient and outpatient rehab. The amount you pay will vary according to your income.
American Addiction Centers can assist you in finding ways to cover your out-of-pocket treatment expenses and help you learn exactly what parts of treatment are covered by Medicaid. Call us at (number) to speak with one of our admissions navigators.
- gov. (2021). Substance Use Disorders.
- gov. (2020, December 30). Mandatory Medicaid State Plan Coverage of MedicationAssisted Treatment.
- Donahue J., Raslevich AC., Cole E. (2020). Medicaid’s Role in Improving Substance Use Disorder Treatment
- Substance Abuse and Mental Health Services Administration. (2014 November). Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders.
- gov. (2020 March 18). Health Insurance and Mental Health Services.
- Kaiser Family Foundation. (2019 November 6). State Options for Medicaid Coverage of Inpatient Behavioral Health Services.
- Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.
- Center for Behavioral Health Statistics.SAMHSA – Substance Abuse and Mental Health Services Administration Key Substance Use and Mental Health Indicators in the United States:Results from the 2016 National Survey on Drug Use and Health. (2017).
- Office of National Drug Control Policy. Substance Use and the Affordable Care Act.
- gov. (2017). Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.
- gov. (2021). Eligibility.
- Insurance Provider Name
- Policy Member's Full Name
- Policy Membership/Subscriber ID