Does Molina Healthcare Insurance Cover Substance Abuse Treatment?
Molina Healthcare Drug and Alcohol Rehab Insurance Coverage
What is Molina Healthcare Insurance?
Molina Healthcare is a managed healthcare company headquartered in Long Beach, California. The company offers healthcare coverage for nearly 4 million people through the implementation of government-based healthcare programs. The company has been in operation for over 30 years. Its primary focus is on providing insurance with state governments through healthcare plans, such as Medicare and Medicaid-based programs as well as some other marketplace exchange programs in some states.
Does Molina Healthcare Cover Mental and Behavior Healthcare?
When a person purchases a healthcare policy through Molina Insurance via a state exchange or marketplace plan, the policy is required by the Affordable Care Act (Obamacare) to provide coverage for mental health services, which includes the treatment of substance use disorders. For individuals who do not acquire a Molina healthcare plan through a state market exchange, the Affordable Care Act requires that private policies also provide some provisions for mental and behavioral healthcare, including provisions for substance abuse. Thus, Molina does provide coverage for substance abuse; however, the actual coverage will vary depending on how the policy was acquired, the state where the individual lives, and whether or not the policy was acquired through a public market exchange or privately. In general, coverage should apply to inpatient treatment programs, residential treatment programs, and outpatient treatment programs, but again, the exact coverage will depend on how the individual acquired the policy, the state the person lives, and the policy itself.
What is the Molina Medicaid Program and How to Apply?
Molina offers Medicaid plans in numerous states, including:
- New Mexico
- South Carolina
Molina also offers Medicaid programs through the State Children’s Health Insurance Program (SCHIP) in these states. Medicaid provides insurance for low-income families.
Medicaid is the largest single healthcare payer in the US for mental health services which include disorder treatment service. An individual’s eligibility for Medicaid is determined by numerous factors, such as a person’s age, their income, the number of people in their household, if the individual has a disability, and so forth.
Individuals can enroll for Molina Medicaid by going to the Health Insurance Marketplace. Once an application is completed, it can be determined what types of programs they may qualify for.
In addition to specific state requirements, the income requirement that applies to Medicaid is based on the designation of the federal poverty level (FPL). Different states have different requirements as to what percentage of income based on the FPL is required for an individual to qualify for Medicaid coverage. Depending on the situation, individuals can have incomes that are a percentage over the FPL, and in some states, individuals with dependent children may qualify for Medicare if they make twice the FPL. The FPL levels are:
- $11,770 for a one-person household
- $15,930 for two-person household
- $20,090 for three-person household
- $24,250 for four-person household
Individuals can also use the Substance Abuse and Mental Health Care Services Administration’s Behavioral Health Treatment Services Locator to find a specific insurance provider in their state that accepts Medicaid. One need not have an active Medicaid plan to be admitted to a substance use disorder treatment program. Once an individual has applied for Medicaid coverage, many programs may accept them.
Medicare Plans from Molina Healthcare Insurance
Molina offers Medicare Advantage healthcare plans that offer comprehensive benefits to individuals through a wide selection of health providers at very low out-of-pocket costs. Medicare is a government-funded assistance program that is available to people over the age of 65 and to some individuals who have certain types of disabilities. Individuals on Medicare do pay a monthly premium, which is based on the person’s income.
Medicare has four different parts that cover different costs.
- Medicare Part A: This program covers the costs of inpatient treatment. Part A will typically cover up to 60 days without a coinsurance payment, but there is a deductible involved. Currently, the lifetime coverage for inpatient psychiatric treatment is 190 days; this applies to freestanding psychiatric treatment centers and not treatment in a hospital wing. Methadone addiction treatment for opiate use disorders is covered under Part A.
- Medicare Part B: Part B is designed to address outpatient treatment costs and typically covers up to 80 percent of approved treatments, leaving the policyholder responsible for the other 20 percent. In some cases, medications can be covered under part B.
- Medicare Part C: Part C is an extended Medicare program that can act as a private insurance program and will incur extra costs.
- Medicare Part D:Part D covers prescription medication costs but does not cover methadone treatment for opiate abuse (covered under part A).
More information can be obtained at Medicare’s website.
Medicaid & Medicare Programs from Molina Healthcare Insurance
Individuals who are disabled or over 65 and have low incomes can qualify for both Medicaid and Medicare programs.
What Types of Addiction Treatment Does Molina Healthcare Insurance Cover?
Many Molina plans provide full or partial coverage for intensive addiction treatment services. These may include:6
- Inpatient rehab programs. This type of intensive and structured treatment requires you to live at the rehab center for a certain number of days/weeks. You will receive daily therapy both individually and in group settings. You may also receive medication-assisted treatment. Staff is at the treatment centers 24/7, and support is provided around the clock to help you focus on your sobriety and recovery. You will likely need to provide pre-authorization for inpatient treatment before your Molina insurance coverage kicks in. Some rehab centers do not accept Molina insurance, so it’s important to ensure ahead of time that the rehab you are considering accepts your insurance.
- Outpatient treatment programs. Many people attend outpatient treatment programs before inpatient treatment. Less intensive than inpatient, outpatient allows you to live at home and maintain your day-to-day life while also completing treatment.
- Partial hospitalization programs (PHPs). Partial hospitalization programs allow you to live at home while you get treatment, and you will spend your days at the treatment facility. This is an option for those who know they can stay sober during the evenings they are not at the treatment center and commit to attending the treatment center every day.
- Intensive outpatient (IOP) treatment. Intensive outpatient treatment generally involves attending treatment programs 3-5 evenings a week. IOP programs allow you to attend work during the day, sleep at home, and attend treatment and counseling sessions in the evenings.
Call Molina insurance using the number on the back of your insurance card to discuss the next steps before selecting a treatment program. They will advise you on how to get preauthorization to begin treatment and will work with you to help you decide which option is best for you.
Does Molina Healthcare Insurance Cover Inpatient Mental Health Facilities?
Yes, Molina Insurance covers mental health care. All outpatient mental health services are a benefit covered by Molina. These services include:7
- Individual and group mental health evaluation and psychotherapy.
- Psychological testing.
- Outpatient drugs and supplements.
- Psychiatric consultation.
- Alcohol misuse screening services.
It is common for people with substance use disorder (drug and alcohol addiction) to have mental health conditions such as anxiety, depression, and PTSD. This is known as “dual diagnosis” or co-occurring disorders. 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.8
Treating mental health conditions at the same time as drug and alcohol addiction is best for optimal treatment outcomes.9In most cases, each disorder impacts the other, and so it is best to look for a rehab facility that offers treatment for mental health conditions along with addiction treatment.
Under the Affordable Care Act, substance use disorder is listed as one of the 10 elements of essential health benefits that insurers must provide.10 Like all American insurance providers, Molina must cover mental health care and treatment. While their insurance plans cover some degree of mental health treatment while you are in rehab, the amount of coverage will depend on your specific policy.
What Determines the Amount of Molina Healthcare Insurance Plan Coverage?
There are always determining factors on whether or not treatment for substance use disorders is covered even under government assistance programs. These considerations include whether or not the facility participates with the insurance program in question. Facilities that do not accept certain types of insurance, such as government-assisted insurance programs, should not be considered for use by individuals who have these policies.
In addition, the services in question need to be determined as medically necessary in order for coverage to be considered. Finally, the referral should have a specific individualized treatment plan in place. This is often completed by a physician, intake personnel, and/or other personnel. Many insurance companies will not consider covering treatment for substance use disorders unless there is a concrete addiction treatment plan. This particularly applies to coverage for inpatient, residential, partial hospitalization, and intensive outpatient treatment programs.
Molina reports that it offers a wide variety of behavioral health services for its members. One of the best ways to proceed is to contact a case manager at Molina Healthcare who will get all the needed information and assist in finding the provider that will best suit the individual’s needs. In addition, case managers can help to arrange transportation to the facility and deal with any other special needs. Inpatient admissions require a pre-certification, and a case manager can make the pre-certification process run smoothly.
What Rehab Centers Take Molina Healthcare Insurance?
Working with an in-network provider is important for keeping costs low. If you have a Molina Healthcare, the following AAC facilities accept this insurance:
- Greenhouse Treatment Center: Located in Grand Prairie, Texas, Greenhouse offers individualized treatment plans and various levels of care in a luxurious setting.
- Recovery First Treatment Center: Recovery First Treatment Center is in Hollywood, Florida, and is a leading rehabilitation center offering high-quality addiction treatment.
- Molina Healthcare. (2021). Important Mental Health and Substance Use Disorder Treatment Information.
- Molina Healthcare. (2021). Outpatient Mental Health Services.
- Substance Abuse and Mental Health Services Administration. (2017, September 7). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
- National Institute on Drug Abuse. (2021). Principles of Effective Treatment.
- Centers for Medicare and Medicaid Services. (n.d.) Information on Essential Health Benefits (EHB) Benchmark Plans.
- Insurance Provider Name
- Policy Member's Full Name
- Policy Membership/Subscriber ID
Check your Molina Healthcare rehab coverage
American Addiction Centers' locations
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