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Does Medicaid Cover Drug and Alcohol Rehab Centers for Addiction?

Table of Contents

Finding Medicaid covered Drug Rehab Centers Near Me

Yes, Medicaid does provide some coverage for drug and alcohol addiction rehab, though the amount of the cost covered varies from state to state and depends on an individual’s income and need for treatment.1 Medicaid is a government-funded insurance program for low-income individuals. Each state’s rules vary, and there are specific guidelines for what behavioral health services—including drug and alcohol addiction treatment—are covered by Medicaid.

Nearly 12% of Medicaid beneficiaries over the age of 18 have a substance use disorder.2 Addiction has a tremendous impact not only on a person’s life but on their community and society as a whole. Understanding that addiction greatly affects individuals, families, and communities, Medicaid provides coverage for rehab and other addiction treatments.

If you want to use Medicaid to cover treatment for drug and alcohol addiction, it is important to choose a rehab facility that accepts Medicaid. Check with the rehab center you are considering before you begin treatment to determine if they accept Medicaid.

You may need to be assessed by your primary care provider and get the necessary paperwork before your insurance coverage kicks in. You can ask the rehab facility what Medicaid requires to cover your treatment; you want to ensure that all of the necessary documentation is provided before you enter rehab.

Does Medicaid cover Substance Abuse 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 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 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.

How many days does Medicaid pay for rehab?

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.

Who qualifies for Medicaid?

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.
  • 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.

Medicaid Sponsored Alcohol and Drug Rehab Centers

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:

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.

How to Check Your Medicaid Coverage for Addiction Treatment?

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.

Sources

  1. gov. (2020). Mandatory Medicaid State Plan Coverage of MedicationAssisted Treatment.
  2. gov. (2021). Substance Use Disorders.
  3. Milbank Memorial Fund. (2020). Medicaid’s Role in Improving Substance Use Disorder Treatment
  4. Substance Abuse and Mental Health Services Administration. (2014). Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders.
  5. gov. (2021). Health Insurance and Mental Health Services.
  6. Center for Behavioral Health Statistics.SAMHSA – Substance Abuse and Mental Health Services Administration Key Substance Use and Mental Health Indicators in the United States:Results from the 2016 National Survey on Drug Use and Health. (2017).
  7. Office of National Drug Control Policy. Substance Use and the Affordable Care Act.
  8. gov. (2017). Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.
  9. gov. (2021). Eligibility.