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Medicaid is a state and federal funding program that can help cover healthcare costs for people who have a lower income or other health disparities. Medicaid may cover some or all of the costs for addiction rehab treatment for those who meet eligibility requirements.
- Medicaid may cover various addiction treatment services, including inpatient and outpatient treatments, counseling, medication-assisted treatment, and aftercare.
- Coverage of treatment type and duration may be limited and can depend on individual diagnoses, risk factors, and treatment requirements.
- To be eligible for Medicaid, individuals must be a certain age, a parent, disabled, or pregnant, and they must meet state income requirements.
What addiction rehab services does Medicaid cover?
Medicaid coverage can vary depending on the state. However, most states offer Medicaid plans that cover inpatient residential treatment, medication-assisted treatment, outpatient addiction treatment, and detox services. Long-term residential care and recovery support may not be covered by Medicaid in all states. [1]
Since the implementation of the Affordable Care Act (ACA) in 2014, Medicaid coverage for medication-assisted treatments, particularly for opioid use disorder, has expanded. Now, most states include medications, such as methadone and buprenorphine, under Medicaid plans. [2]
Medicaid will cover all or some of the required services for substance use treatment. Each state may differ regarding the amount of coverage, type and duration of covered services, and out-of-pocket limits. [3]
Medicaid coverage for inpatient and outpatient rehab
The 2014 ACA expansion has led to an increase in the number of states that offer Medicaid coverage for certain treatments, although not all states have implemented these changes. As such, Medicaid coverage for treatment type and duration can vary significantly from state to state. In most states, covered treatments include: [1][4]
- Screening and assessment
- Outpatient treatment programs
- Intensive outpatient treatment programs
- Detoxification services
- Opioid use disorder medications
- Residential rehab
Covered services that differ by state include short-term inpatient care, long-term inpatient care, and recovery support services. [1]
Related: Outreach, Screening, Assessment, and Referral Services in Texas
How to qualify for Medicaid addiction rehab coverage
To qualify for Medicaid, people must be in one of the following categories: [5]
- 65 years old and over
- 19 years old or under
- Have a disability
- Pregnant
- Parent or caretaker of a child
Additionally, Medicaid eligibility is dependent upon annual income. Eligibility rules can change each year, and criteria also vary slightly by state. This information can be found on the government Medicaid website. Requirements depend on the total household income. People may be eligible if they earn under 100-200% of the federal poverty level (FPL).
People who are eligible can apply with the following documentation:
- Identification, such as a birth certificate or driver’s license
- Tax returns and proof of income
- Bank statements
- Proof of address
- Medical records
How long does Medicaid pay for rehab?
Medicaid plans can limit the duration of addiction treatment services, which may vary depending on the individual or state. For example, inpatient treatment could be capped at a certain number of days, although many states will allow extensions in necessary circumstances. [1][6]
Therapy, whether received in a residential facility or through an outpatient program, may be limited to a certain number of sessions or hours per year. However, treatments that are deemed necessary will often not be limited and will be determined on a case-by-case basis. [1]
What to do if Medicaid doesn’t cover rehab
People who do not qualify for Medicaid may be able to receive a state or federal subsidy or a grant from organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA). These options may also involve meeting eligibility criteria. [7]
FAQs
Does Medicaid cover detox?
Yes, in most states, Medicaid covers detox services.
Does Medicaid cover sober living?
Medicaid may be unlikely to cover sober living homes, as they are not considered treatment facilities. [8]
What happens if Medicaid coverage runs out during rehab?
If you reach the limit of coverage offered by Medicaid during your treatment, you may have to pay for the remaining duration of treatment. Some people might be eligible for additional grants or funding to assist with these costs.
Are all addiction treatment centers covered by Medicaid?
Not all addiction treatment centers will allow Medicaid payment plans. It is recommended to discuss all options with the treatment provider before commencing treatment to ensure that your care is covered.
The Recovered Directory can help you find rehab providers in your area.
