Does Medicaid Cover Drug & Alcohol Rehab?
Medicaid can be an extremely useful method for paying for drug and alcohol treatment, including medication-assisted treatment (MAT), inpatient rehab, outpatient rehab, and more.
To learn more about how Medicaid may help you or a loved one pay for inpatient or outpatient drug and alcohol treatment, continue reading. American Addiction Centers is here to help you find treatment, attend treatment, and improve your overall health and wellness.
What is Medicaid?
Medicaid and the Children’s Health Insurance Program (CHIP) provide affordable health coverage to eligible low-income adults, children, and people with disabilities. They are funded by both state and federal government and overseen by individual states under federal guidelines.1 The largest payer for mental health services in the United States, Medicaid also has an ever-growing role in the reimbursement of services for substance use disorders.2
In all 50 states and the District of Columbia, more than 74 million Americans are enrolled in Medicaid, as reported in March 2021.1 If you include CHIP, that number jumps to more than 81 million Americans enrolled in either Medicaid or CHIP as of March 2021.1
Medicaid is a program that is essential for low-income families and other eligible populations, as it allows for a continuum of care for treatment and recovery that can connect people with social services to meet their particular needs.3
How to Check Your Medicaid Coverage
If you are wondering whether or not Medicaid may cover your rehab stay, you can either call your insurance agent, call Medicaid’s member services, or fill your information into the form below.
Statistics on Medicaid in the US
- The Affordable Care Act of 2010 (ACA) allows states to expand Medicaid coverage to nearly all low-income adults under the age of 65.6
- Almost 12% of Medicaid recipients over the age of 18 have a substance use disorder.2
- Every day, over 6,500 people seek emergency services for substance-related issues.2
- Medicaid was the source of payment for more than 42% of all births in the U.S. in 2018.7
- In 2017, Medicaid paid for more than 30% of long-term care for those in nursing care facilities and continuing care retirement communities.7
Are MAT Medications Covered by Medicaid?
In 2020, the Federal government issued guidelines for states to increase access to medication-assisted treatment (MAT) for opioid use disorders. States are now required to provide Medicaid coverage for certain drugs, counseling, and behavioral therapy.8
Some of the more common drugs used in MAT for opioid use disorders are:9
- Methadone: An opioid agonist, it acts on opioid receptors in the brain more slowly and without producing the euphoric effects of opioids like heroin. Methadone helps by reducing withdrawal symptoms and cravings.
- Buprenorphine: A partial opioid agonist, it also acts on the opioid receptors in the brain, but is not as strong as methadone and can be taken outside of an approved treatment facility. It helps reduce withdrawal symptoms and cravings.
- Naltrexone: An opioid antagonist, it works differently than methadone or buprenorphine. Naltrexone blocks opioid receptors in the brain and prevents any opioid drug from producing euphoric effects.
Length of Rehab Stay Covered by Medicaid
The length of time a person spends in rehab depends on their individual needs as well as their specific provider benefits. There is no predetermined length of treatment that applies to everyone. However, evidence indicates that treatment outcomes are contingent on adequate treatment length.10
Each state has different rules for eligibility and treatment coverage for inpatient rehab. Prior to the ACA, addiction treatment services were often not covered by private insurance and were extremely limited for people with public insurance.11 Insurance companies now have to provide a full range of treatment services, including residential treatment for substance use disorders.11
Inpatient treatment can last anywhere from 5-7 days for medical detox and up to 90 days or more depending on a person’s needs and how they progress in treatment. Outpatient care can last a year or more.12
Does Medicaid Cover Out of State Rehab?
The amount of coverage for residential services or outpatient treatment that Medicaid will cover varies by state. You can call any treatment facility to determine if your insurance is accepted, as each state has different eligibility requirements.
Rehab and Other Insurance
It is possible to have Medicaid supplement private insurance. In most cases, Medicaid acts as the “payer of last resort” for services. Generally, other responsible sources of payment are required to pay for medical costs before Medicaid will do so.15
As requirements can vary substantially from state to state, it will be imperative to work with individual treatment centers to determine what services are covered through individual policies and how much they will cost.
American Addiction Centers offers inpatient rehab in the United States. Call
Who is Eligible for Medicaid?
Low-income families, qualified pregnant women and children, and people who receive Supplemental Security Income (SSI) are examples of mandatory eligibility groups.16 Other communities, like children in foster care who are not otherwise eligible or people who receive community-based services, may also qualify, depending on the state.16
Determinants of eligibility include but are not limited to:16
- Financial need: within income guidelines for individuals and families.
- Medically necessary: includes people whose income is too high to meet financial criteria but have qualifying disabilities.
- Age: children or people over 65.
Medicaid Income Brackets
While individual states have a wide range of eligibility requirements for Medicaid, they are directed by federal guidelines. Eligibility is primarily influenced by federal poverty levels in each state.17
Below is a table of federal poverty guidelines for states in the contiguous U.S. and the District of Columbia:17
Persons in Family or Household Poverty Guideline
- $12,880 for individuals.
- $17,420 for a family of 2.
- $21,960 for a family of 3.
- $26,500 for a family of 4.
- $31,040 for a family of 5.
- $35,580 for a family of 6.
In states that expanded Medicaid benefits as a result of the ACA, people who earn 138% above poverty level can qualify for Medicaid. Income limits are much lower in states that have not expanded Medicaid benefits since the ACA.17
Medicaid Detox Programs
State-funded detox and rehab programs provide services at a lower cost than private facilities. They are funded by state and federal programs, grants, and tax dollars, and they often accept Medicaid.20 These facilities are essential to the treatment of and recovery from substance use disorders for people who cannot afford private programs, which may cost thousands of dollars per day. Both residential facilities and outpatient treatment are available through state-funded programs.20
Medicaid Inpatient Programs
In 2015, the Obama administration issued guidance to outline how states could potentially cover inpatient and residential treatment for substance use disorders to ensure a comprehensive continuum of care as outlined by the American Society of Addiction Medicine (ASAM).3 The ASAM levels of care encompass early intervention, outpatient services, intensive outpatient treatment, partial hospitalization services, inpatient services, and medically-managed intensive inpatient treatment.
Medicaid Outpatient Rehab
States can use Medicaid’s rehabilitation services option to cover some outpatient treatment for substance use disorders.3 Outpatient treatment options like MAT, counseling, and case management can allow for people in recovery to continue to work and care for their families.
Medicaid for Mental Health Counseling and Substance Abuse Therapy
All state Medicaid programs provide some mental health services, and many provide services for substance use disorders as well.13 They typically include counseling, therapy, MAT, peer services, and various levels of care for addiction treatment.13
Find Drug & Alcohol Rehab Centers Near You
- Medicaid.gov. (2021). Medicaid.
- Medicaid.gov. (n.d.). Behavioral Health Services.
- Bailey, A., Hayes, K., Katch, H., Solomon, J. (2021). Medicaid is Key to Building a System of Comprehensive Substance Use Care for Low-Income People, Center on Budget and Policy Priorities.
- Medicaid.gov. (2021). Substance Use Disorders.
- Medicaid.gov. (n.d.). Parity.
- National Conference of State Legislatures. (2011). Medicaid and the Affordable Care Act.
- Center for Medicare and Medicaid Services (CMS). (2020). Medicaid Facts and Figures.
- Center for Medicare and Medicaid Services (CMS). (2020). SHO# 20-005 RE: Mandatory Medicaid State Plan Coverage of Medication Assisted Treatment.
- National Institute on Drug Abuse (NIDA). (2018). Opioid Agonists and Partial Agonists (Maintenance Medications.
- National Institute on Drug Abuse (NIDA). (2018). How Long Does Addiction Treatment Usually Last?
- Abraham, A., Andrews, C., Grogran C., Daunno, T., Humphreys, N., Pollack, H., Friedmann, P. (2017, January). The Affordable Care Act Transformation of Substance Use Disorder Treatment. National Center for Biotechnology Information (NCBI).
- Lesser, B. (2021). How Long Should Rehab Stay Be?
- Mental Health.gov. (2020). Health Insurance and Mental Health Services.
- American Society of Addiction Medicine (ASAM). (2018). The SUPPORT for Patients and Communities Act.
- Medicaid and CHIP Payment and Access Commission. (n.d.). How Medicaid Interacts with Other Payers.
- Medicaid.gov. (n.d.). Eligibility.
- Assistant Secretary for Planning and Evaluation (ASPE). (2021). S. Federal Poverty Guidelines to Determine Eligibility for Federal Programs.
- S. Department of Veteran Affairs. (2020). VA Healthcare and Other Insurance.
- Center on Budget and Policy Priorities. (2020). Taking Away Medicaid for Not Meeting Work Requirements Harms Veterans.
- NIDA. (2018). Drug Addiction Treatment in the U.S.