Most insurance plans will cover either all or a portion of the treatment.
- Content Reviewed By:
- Andrew McKenna - JD
- SUD's treatment executive, national news contributor & keynote speaker.
Navigation:
- Overview
- How Does Medicaid for Addiction Treatment Work?
- How Much of My Treatment Will Medicaid Cover?
- Can I Qualify for Medicaid?
- What Kind of Treatment Services Does Medicaid Insurance Cover?
- Can I Combine Medicaid Coverage with Private Insurance?
- Are Medicaid-Funded Rehab Programs Adequate for Treatment?
- Medicaid Resources
Overview
Medicaid is one of the most common means of state funding for addiction treatment centers. It’s the primary source through which patients with no or limited means get the help they need for their alcohol or drug dependency. Medicaid is an ideal option for those who need alcohol or drug treatment but don’t have any private health insurance.
These programs generally cover detox (medically supervised withdrawal management) as well as outpatient treatment centers. In limited cases, Medicaid may fund inpatient or residential treatment facilities, but outpatient coverage is more common due to the cost differential.
Data from Medicaid indicates that nearly 12 percent of Medicaid beneficiaries over 18 suffer from substance use disorder (SUD). If you or your loved one are among these numbers, help is available through Medicaid coverage.
How Does Medicaid for Addiction Treatment Work?
The federal government disperses Medicaid to different states through block grants and other allocation vehicles. Each state has its own eligibility requirements, so coverage may be more accessible in some states than others. Coverage rates and models change on a regular basis, so it’s essential to understand your rights and responsibilities under your specific state plan. You can apply for Medicaid through the main website and get a more detailed breakdown of your state’s coverage options through personnel administering your program.
How Much of My Treatment Will Medicaid Cover?
While the amount of Medicaid coverage for your treatment will vary from state to state, recipients typically have to pay for at least some portion of their care out of pocket. Your payment obligations will also vary depending on what type of treatment you’re seeking. Inpatient treatment will typically require a higher out-of-pocket obligation than outpatient treatment because it’s more expensive as a whole. Although Medicaid has grown significantly since the advent of the Affordable Care Act, some states don’t have the resources to fund inpatient treatment readily and will sometimes only cover treatment with a more limited scope.
Can I Qualify for Medicaid?
Medicaid eligibility is generally based on income and family size, so as long as you meet the income requirements, you will qualify. In all states, Medicaid gives health coverage to some individuals and families, including children, parents, people who are pregnant, elderly people with certain incomes, and people with disabilities.
Some states have expanded their Medicaid programs to cover other adults below a certain income level. States may also cover additional groups, such as individuals receiving home and community-based services and children in foster care who may not otherwise qualify. Recipients must also reside in the state in which they’re seeking Medicaid Coverage.
What Kind of Treatment Services Does Medicaid Insurance Cover?
Medicaid-funded substance use disorder treatment varies from state to state. Different states have more expansive coverage than others. One universal element of Medicaid coverage, however, is medication-assisted treatment (MAT) for opioid use disorder.
To increase access to medication-assisted treatment (MAT) for opioid use disorders (OUD), the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act requires states to provide Medicaid coverage of certain drugs and biological products, and related counseling services and behavioral therapy.
These drugs may include methadone, Suboxone® (buprenorphine and naloxone), or Vivitrol® (monthly injectable naltrexone). Medicaid will also cover behavioral rehab (CBT), including group therapy and individualized psychological counseling.
Can I Combine Medicaid Coverage with Private Insurance?
The short answer is yes, but it may be more challenging than choosing the single-best coverage source to fund your care. States generally require entities other than Medicaid programs to fund coverage prior to their Medicaid plans kicking in. This is what’s known as Third Party Liability (TPL).
Examples of third parties that may be liable to pay for services include, but are not limited to:
- Group health plans
- Self-insured plans
- Managed care organizations
- Pharmacy benefit managers
- Medicare
- Court-ordered health coverage
- Settlements from a liability insurer
- Workers’ compensation
- Long-term care insurance
- Other state or Federal coverage programs (unless specifically excluded by law)
Are Medicaid-Funded Rehab Programs Adequate for Treatment?
There’s often a misconception that rehab centers that take Medicaid are of lower quality than their privately funded counterparts. The truth is that Medicaid-funded treatment sources are staffed with experienced, qualified, and dedicated clinical staff and generally offer a diverse array of evidence-based clinical programming.
While it’s true that Medicaid doesn’t typically cover higher-end luxury treatment programs, they provide robust clinical and behavioral care for those who need it. The distinction often lies in amenities and quality of life between the two types of programs, but Medicaid-funded programs have proven to be a critical lifeline for lower or moderate-income Americans who are battling addiction. The most important thing is to get help however possible.
Medicaid Resources:
