Does Medicaid Cover Drug Addiction Therapy?
Almost 12% of people over the age of 18 who use Medicaid suffer from a substance use disorder.12 The Centers for Medicare & Medicaid Services (CMS) aims to create effective strategies for helping these individuals undergo treatment. This way, they can reduce the death toll of SUDs, their detrimental impact on the society, and the financial expenses associated with them.12
Under the Affordable Care Act, Medicaid coverage has to cover some SUD treatment services in all states, but the extent of the coverage varies.13 Also, the Mental Health Parity and Addiction Equity Act stipulates that patients should receive the same benefits for mental and/or substance use treatment as for medical/surgical care.14 In the National Survey of Substance Abuse Treatment Services conducted in 2018, 9,706 (65.5%) of treatment facilities accepted Medicaid coverage.15 This means that patients who couldn’t otherwise afford treatment have available options at their disposal.
Does Medicaid Cover Short-Term Rehab?
Yes, Medicaid may cover your short-term rehab in part or in full. Under the SUPPORT for Patients and Communities Act, Medicaid beneficiaries with SUDs must have access to a comprehensive range of outpatient rehabilitation services, including early intervention, partial hospitalization, outpatient treatment, and intensive outpatient treatment.16
In addition, the law mandates that states cover two or more other treatment services:16
Low-intensity residential treatment in a clinical setting
Intensive residential treatment in a clinical setting
Medium-intensity residential treatment for adolescents in a clinical setting
Intensive residential treatment for adults in a clinical setting
Medically-assisted intensive inpatient treatment for adolescents
Medically-assisted intensive inpatient detox for adults
Medically-assisted intensive inpatient treatment
The state is required to conduct a suitable evidence-based assessment of the individual before they enter treatment at an eligible facility as well as to perform regular re-evaluations. The purpose of these assessments is to determine what type and duration of treatment is suitable for the person.16 People who are enrolled in the Medicaid program can check their coverage by logging onto their HealthCare.gov account, use Mental Health and Addiction Insurance Help to find out, or verify their insurance by contacting their chosen rehab facility.17,18
Does Medicaid Pay for Court-Ordered Rehab?
An individual who needs to enter court-mandated SUD treatment is legally obliged to pay for it. It may be possible for Medicaid to cover the cost of your court-ordered rehab either partially or in total.16
As is the case with Medicaid coverage of other levels of care for SUDs, this depends on your state’s regulations. An in-network provider often has to confirm that the patient’s treatment is medically necessary and they have to get treated at a center that accepts Medicaid.16
Does Medicaid Pay for Residential Treatment?
Some types of residential inpatient services are covered by Medicaid in all states.16 However,
payments for residential services won’t necessarily cover the price of room and board unless the facility fits certain criteria. Room and board payment is only granted for:16
Inpatient hospitals.
Nursing facilities.
Psychiatric hospitals for people under 21.
Intermediate care centers for patients with intellectual disabilities.
Centers for people over 65 that would otherwise be classified as inpatient facilities.
Does Medicaid Cover Medication-Assisted Treatment Programs?
Yes, your Medicaid plan may cover medication-assisted treatment (MAT). To be approved for Medicaid coverage, facilities have to provide at least two kinds of medication for MAT onsite.16 In addition to this type of treatment, they also need to offer mental health services.16
Does Medicaid Cover Opioid Treatment?
As part of a larger campaign to put a stop to the nationwide opioid crisis, under Medicaid there is a comprehensive support system for people struggling with opioid addiction.19 States get federal financial participation for the full continuum of treatment options that address opioid addiction, including residential treatment services.19
Since states apply Medicaid flexibly and the regulations concerning SUD treatment coverage are susceptible to change, it’s always advisable to check your plan for the extent of coverage for opioid addiction treatment.
Does Medicaid Cover Methadone Treatment?
All states have to cover all medications approved for MAT by the Food and Drug Administration (FDA).20 The FDA has approved methadone, buprenorphine, and naltrexone to be used for MAT of opioid use disorders. Multiple considerations influence which medication is given to a patient.20
Does Medicaid Pay for Suboxone Treatment?
If the facility provides medically-assisted treatment for opioid addiction, they have to offer at least one FDA-approved partial agonist (suboxone, also known as buprenorphine) as well as an antagonist (like naltrexone).16 Since buprenorphine has been approved by the FDA as a medication used to treat opioid use disorders, state plans have to cover it.20
Does Medicaid Pay for Sober Living?
Some sober living facilities are Medicaid-covered and states are encouraged to support patients in their transition from more intensive levels of care.16 However, similarly to the costs at other levels of care, every state has different regulations when it comes to funding stays at sober living houses.16 Patients need to check whether their state provides coverage for transitional housing under Medicaid.