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Does Medicaid
Cover Rehab?

Does Medicaid
Cover Rehab?

Treatment for drug addiction can be expensive, but that doesn’t mean people who are low income cannot get the help they need. Those who qualify for Medicaid are able to receive many of the same addiction treatment services as those with private insurance. This page includes information on the services provided by Medicaid, as well as how to find rehabs that take Medicaid and utilize other payment methods to get this vital treatment.

Treatment for drug addiction can be expensive, but that doesn’t mean people who are low income cannot get the help they need. Those who qualify for Medicaid are able to receive many of the same addiction treatment services as those with private insurance. This page includes information on the services provided by Medicaid, as well as how to find rehabs that take Medicaid and utilize other payment methods to get this vital treatment.

By the Numbers: The Cost of Addiction

Rehabs that Take Medicaid: What’s Covered

Generally speaking, rehabs accept Medicaid for a variety of pharmacological and counseling-related substance abuse treatments. The following are some of the services the agency covers.

Screenings are used in order to determine if someone has a problem with drug or alcohol abuse. During this process, medical professionals use interviews or self-reports to determine if treatment will be needed.

Health care professionals perform assessments in order to obtain a detailed picture of the patient’s situation and create a treatment plan that is appropriate for them. This is done by conducting interviews with the person seeking treatment, as well as family members and significant others. When the process is complete, decisions are made about the level of care they should receive, and also what additional support will be needed after they’re discharged from rehab.

Residential treatment is for patients who will benefit from having their daily routine and patterns disrupted by receiving care in a safe, structured environment where help is available 24 hours a day. Patients who receive residential services get psychotherapy combined with medication-assisted treatments. In addition, peer support, crisis stabilization, case management, and relapse prevention services may be available.

Patients who get intensive outpatient treatment are required to receive services for around six to 19 hours each week—which could be during the day, evening, or weekends.

Partial hospitalization, or day treatment, refers to clinically intensive treatment that is provided at least twenty hours per week. This rehab is for people who don’t require services 24 hours a day, but will not get the best health outcomes with outpatient care. In these programs, patients receive daily monitoring to track their progress as they participate in medication management and group, individual, or family therapy.

Medication-assisted treatment is part of any holistic substance abuse treatment, as it allows patients to stabilize physically while they confront their addiction psychologically and emotionally. To that end, medications are chosen based on the substance patients abused, how long they used the substance, and what other health challenges they may be dealing with. Drugs that may be used for this treatment include methodone, naltrexone, disulfiram, buprenorphine, and acamprosate.

Every patient getting addiction treatment has individual objectives for success, and individual counseling is designed to address them. During this time, co-occurring mental illness is treated, problem-solving and coping skills are developed, and emotional and psychological trauma is tackled.

Group counseling provides patients with an opportunity to practice social interactions that don’t revolve around using drugs or alcohol while getting support from their peers. People in group therapy share their personal experiences and give each other feedback so they can each gain the skills they need to adapt to a sober lifestyle.

Family behavior counseling focuses on how a patient’s home environment can be improved to foster sobriety. This therapy may include parents, children, siblings, spouses, cohabitating partners, or extended family members like grandparents or cousins. During these sessions, each member of the family gains insight on how they can change their behavior to promote harmony and healthy relationships in the home, while helping their loved one remain clean and sober.

This type of therapy is designed to solidify a patient’s desire to change and give them the motivation to take steps needed for a clean and sober lifestyle. During these sessions, therapists help patients embrace a plan to change their behavior and teach them the skills they need to handle any temptation that arises.

The goal of cognitive behavioral therapy, or CBT, is to produce long-lasting change by tackling the maladaptive thoughts and behaviors that contributed to patients’ drug or alcohol abuse. Patients learn how to identify situations that put them at risk of substance use, recognize when they’re having cravings before they succumb to them, and utilize coping strategies when triggers arise.

Who Is Eligible for Medicaid?

Patients who need treatment for an addiction can qualify for Medicaid by meeting one of the following criteria:

  • Earning 133 percent less than the federal poverty level
  • Falling into a certain income bracket if they are above the poverty level
  • Being eligible for Supplemental Security Income
  • Being over 65 years of age
  • Being under 19 years of age
  • Being pregnant
  • Being a parent

Finding Rehabs That Take Medicaid

Although it may seem daunting to find drug rehab centers that accept Medicaid, patients can get help locating facilities that will meet their needs. Some of the ways people can do this is by:

  • Talking to a caseworker at their local Medicaid office in order to get information about treatment options and what services will be covered by the agency.
  • Directly contacting rehab centers that they’re interested in and asking if they take Medicaid. If they don’t, people can ask the center for a recommendation on what facilities they can contact.
  • Using the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator.
  • Speaking to someone at their county health board for recommendations.

Does Medicaid Cover Rehab That Is Court Ordered?

In some states, people who are mandated by the court to enter a rehab program can have their treatment paid for through Medicaid. For example, in New York State, Medicaid managed care organizations are required to provide services to drug court participants based on the type, length, and provider of treatment determined by the court. Similarly, in Rhode Island, the state’s Family Court Juvenile Drug Court has been able to pay for services that may not be available but for reimbursement from Medicaid.

Medicaid Tackles the Opioid Epidemic

According to the Centers for Medicare and Medicaid Services, the opioid epidemic has had a disproportionate effect on those who receive these benefits because Medicaid patients are two times more likely to receive prescription painkillers than those who are not Medicaid recipients. As a result, the agency has created initiatives to solve the problem, which include increasing the use of naloxone, which is designed to prevent opioid overdoses; improving opioid prescribing practices; and expanding overdose prevention education.

Medicaid Alternatives

Those who need treatment for alcohol and drug abuse can get help paying for their services through a variety of non-Medicaid sources. The following are some of these options, which include government programs that help with treatment, funding agreements that can be made directly with a specific rehab facility, and steps an individual can take on their own to obtain money for a rehabilitation program.

  • Medicare and Substance Abuse Treatment
  • State-Funded Rehab
  • Access to Recovery (ATR) Voucher
  • Just as Medicaid recipients can receive treatment for addiction to drugs or alcohol, people eligible for Medicare—those who are disabled or 65 years old and above—can get the help they need on an inpatient or outpatient basis. For those who need inpatient care, Medicare will pay for 190 days spent in a psychiatric hospital for substance abuse treatment. Medicare recipients who need outpatient treatment for addiction can receive a variety of services, including an assessment, a brief intervention, methadone therapy, and counseling.

  • Another option for those who may not be able to afford drug and alcohol treatment is to enter a state-sponsored program. In some cases, these rehabs are free of charge, while other facilities may require a nominal payment compared to what they would be charged in private rehabilitation centers. In order to qualify for treatment through a state-funded rehab program, patients may be required to provide proof of state residency, income, and legal status, as well as have a discussion with the facility about the nature of their addiction.

    State-sponsored rehab programs can be found on the Substance Abuse and Mental Health Services Administration’s Directory of Single State Agencies (SSAs) for Substance Abuse Services.

  • Access to Recovery Voucher, or ATR, is a federally-funded program that was created in order to provide low-income individuals with access to the rehab of their choice—based on which facilities in their area are participating in the program—for 90 days. Through this program, patients can receive inpatient or intensive outpatient treatment, as well as counseling. In addition, Access to Recovery subsidizes services that facilitate patients’ ongoing sobriety, including continuing care, vocational training, transportation assistance, life coaching, legal services, employment coaching, childcare services, spiritual support, recovery checkups, and basic needs like food and clothing.

    In order to qualify for an ATR voucher, patients must be a minimum of 18 years of age, make an annual income that is 200 percent below the federal poverty level, live in a county that provides ATR services, and have a history of substance abuse. ATR programs can be found through the Substance Abuse and Mental Health Services Administration.

More Options for Paying for Addiction Treatment

Even if people who are struggling with addiction cannot find rehabs that accept Medicaid, there are still ways they can get help paying for their treatment. The following are some of these alternative options.

Some drug and alcohol treatment programs adjust their fees based on their patients’ ability to pay. In order to be considered for a sliding fee scale, patients provide information about their income, monthly expenses, dependents, and cash on hand, which is used by the facility to determine a reasonable price for its services.

Although they are not common, some rehabilitation centers offer free services to patients. These programs may be made available through faith-based groups and charities that are dedicated to helping those who are less fortunate get the treatment they need. Free programs may be found by searching the Behavioral Health Treatment Services Locator provided by the Substance Abuse and Mental Health Services Administration.

By using crowdfunding sites such as Crowdrise, GoFundMe, and IndieGoGo, people can raise money for their treatment from their friends and family. In addition, the addicted person’s loved ones may share their campaign with other people they know, increasing the chances of getting donations from kind people who want to help with their sobriety.

Drug and alcohol rehabilitation programs understand that people who need help may not be able to pay for it in one lump sum. In order to help them get the treatment they need without having to worry about how they’ll pay for it, some centers offer monthly payment plans that are tailored to each patient’s unique financial situation.

People who are in the throes of addiction may sell their personal property in order to get their next fix. However, they can also use this tendency for their benefit by selling some of their belongings to help defray the cost of treatment.