Medicaid Insurance for Addiction Treatment

Medicaid is the largest payer for substance use disorder treatment and recovery services in the United States.³ If you are seeking drug addiction treatment and have Medicaid health insurance, you are not alone. Medicaid covers 40% of people with opioid use disorder and more in states that have expanded access to Medicaid under the Affordable Care Act.³

All state Medicaid programs across the country provide some coverage for substance use disorder treatment. These services often include:⁴

• Initial screening.
• Intervention.
• Medications for managing cravings and withdrawal.
• Inpatient rehab.
• Long-term residential treatment.
• Detox.
• Outpatient rehab (e.g., partial hospitalization programs, intensive outpatient programs).
• Other mental health services (e.g., therapy, counseling).

What is Medicaid Insurance? 

Medicaid is a government program that offers low-cost or free-of-charge healthcare to over 75 million American citizens.1 Medicaid covers eligible low-income individuals, seniors, people with disabilities, pregnant women, children, and families.11 While Medicaid is in part run by the federal government, states have considerable flexibility in administering it, so Medicaid coverage varies based on the policies of each state.11

What does Medicaid cover for mental health?

Additionally, all state Medicaid programs offer some coverage for mental health services and substance use disorder treatment. These services often include:⁵

• Counseling.
• Therapy.
• Medication management.
• Social work services.
• Peer supports.

Many people with substance use disorder also have other mental health conditions such as anxiety, depression, PTSD, and mood disorders. These are known as co-occurring disorders, sometimes referred to as dual diagnoses. 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.⁶

It is important to treat co-occurring disorders and substance use disorders at the same time because these conditions can impact each other. Try to choose a rehab facility that offers mental health care as well as addiction treatment.

Does Medicaid Insurance cover mental health hospitalization?

The Affordable Care Act lists substance use disorder as one of the 10 elements of essential health benefits that insurers must provide. As a result, all insurance providers in the U.S., including Medicaid, are required to offer coverage for mental health care and treatment.⁷ Both rehab and mental health care services fall under this mandate. The amount of rehabilitation costs covered by Medicaid varies from state to state. You can call Medicaid directly to inquire about your coverage details or contact the rehab center you are considering directly so they can check your benefits for you while you are on the phone.

The length of time Medicaid covers rehab varies. Generally, Medicaid has limits on the amount of coverage per year in categories of treatment. For example, inpatient treatment duration may be limited to a certain number of days per calendar year. Most treatment duration, however, is based on individual patient needs.^{[8, p15]}

Inpatient rehab centers typically admit residents anywhere from 15-90 days, though this too can vary based on individual needs. Treatment length is often long-term to help prevent relapse and encourage life-long sobriety.

You can look up the details of your Medicaid plan by calling the number on the back of your insurance card. Alternatively, you can contact the rehab center directly and they can check your Medicaid benefits for you while you are on the phone. While Medicaid also offers a wealth of information about substance use disorder treatment on their websites, it may be more helpful to speak directly with a person on the phone so they can answer any questions you have and point you in the right direction for finding a treatment center that accepts Medicaid.

You can also find a treatment facility that accepts Medicaid by searching the Substance Abuse and Mental Health Services Administration (SAMHSA) website or calling their information hotline directly.

Medicaid is a government-funded public insurance program for low-income individuals and families. Medicaid covers some aspects of drug and alcohol dependency treatment.

To be eligible for Medicaid, applicants must be one or more of the following:⁹

• Over 65 years old.
• Under 19 years old.
• Pregnant.
• A parent.
• Within a specified low-income bracket.

In some states, Medicaid covers all adults below a certain income level, even if you do not fit into one of the aforementioned categories. You are also typically eligible for Medicaid if you receive supplemental security income. To determine if you are considered low-income, your total household income must be below the federal poverty level as determined by the Affordable Care Act. However, you may still be eligible to receive Medicaid if you fall within a certain income bracket above the federal poverty level.

Speak to your state’s Medicaid provider about eligibility requirements in your state to determine for certain if you qualify for Medicaid coverage.

Looking for an affordable rehab center can be frustrating and exhausting. However, the process can be pretty straightforward as long as you are well-informed and know where to seek out information. The important thing to keep in mind is that Medicaid can help you reduce or even eliminate the cost of drug and alcohol addiction treatment. This can bring comfort and peace of mind so you can focus on what truly matters—your sobriety and recovery. Don’t let the cost of rehab deter you from seeking treatment.

The Centers for Medicare and Medicaid Services (CMS) releases information on effective practices for treating substance abuse disorders. If you are looking for rehabs that take Medicaid for addiction treatment, consider these resources:

• Find Treatment Centers that Accept Medicaid
• Delivery Opportunities for Individuals with a Substance Use Disorder.
• Finding Addiction Treatment.

Medicaid is the single largest payer for mental health and substance abuse in the United States. If you qualify for Medicaid or already have it, know that at least part if not most of your treatment costs will be covered.

Some states may require that you pay copayments, coinsurance, and deductibles on inpatient and outpatient rehab. The amounts you’ll be required to pay will vary, depending on your income.

American Addiction Centers can help you determine what is covered by Medicaid and assist you in speaking to relatives about financing any out-of-pocket treatment expenses. Give us a call at to speak with one of our admissions navigators. We are happy to help.

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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.