Are you a concerned spouse, parent or loved one of someone struggling with drug or alcohol addiction? Maybe you want things to improve and are ready to take the next step towards healing, but you just can’t help wondering: Does Medicaid help with rehab? How much will this cost me? Is it even possible to get treatment with Medicaid insurance?

We’ll help you make sense of the following:

  • Government statistics related to addiction in the United States.
  • Medicaid coverage for adults suffering from addiction to drugs or alcohol.
  • Medicaid coverage for children struggling with Substance Use Disorders.
  • Treatment options requiring prior authorization before you can enter a drug rehab.
  • Potential out-of-pocket expenses that you must be prepared for.
  • Restrictions that may apply to your situation and Medicaid coverage.

Addiction does not discriminate. It can ravage families of any race, creed, culture, income level or spiritual foundation. And if left untreated, the damage can be disastrous.

CDC Addiction Statistics

Based on reports from the Center for Disease Control (CDC), beginning in early adolescence, an overwhelming 10% of persons have partaken of illicit substances within this past month. SAMHSA, the government foundation monitoring addiction statistics in the U.S., tells us that:

  • More than 20 million adults are diagnosable with substance abuse disorder (SUD).
  • This is almost 1 in every dozen adults in the U.S.
  • 7.7 million adults struggle with a co-occurring disorder accompanying substance abuse.

According to these statistic, it is very likely that you will encounter a situation affected by addiction at some point in your lifetime. Knowing what your insurance covers is one of the first steps to taking a stand for recovery.

Medicaid Coverage for Adults in Drug Rehab

Over the past several years, Medicaid has grown in its ability to reimburse for chemical dependency treatment in the U.S. The Mental Health Parity and Addiction Equity Act, enacted in 2008, spread Behavioral Health Services coverage to Managed Care Organizations, CHIP and the State alternative benefit plans.

It is important to note that some states declined this extension of services. Coverage is dependent upon the state you live in and your income level. In a household that makes fewer than $16,000 per year, you might qualify for these benefits.

Under the 2010 Affordable Care Act (ACA), Medicaid has to cover every basic aspect of substance abuse treatment. As deemed medically necessary by professionals, Medicaid covers all or most of the following services:

  • Periodic screenings for chemical dependency or abuse.
  • Detoxification from the substance.
  • Long-term or short term in-patient treatment.
  • Outpatient services including counseling and therapy.
  • Maintenance and craving interventions.
  • Family therapy and trauma resolution.
  • Recovery maintenance and relapse prevention services.

Medicaid Rehab Coverage for Children

The Children’s Health Insurance Program (CHIP), enacted in 1997, allows for federally matched funds to states that provide health coverage to children of families with earnings too high to qualify for Medicaid, but who are still unable to purchase private coverage. This program is used by every state, with almost all states allowing coverage for kids up to 200% of the Federal Poverty Level.

Approximately 6% of teens between 12 and 18 were diagnosed with substance abuse or substance dependent disorders in 2012. CHIP provides substance abuse treatment coverage to children, with applicable out-of-pocket fees. The Medicaid Early and Periodic Screening, Diagnostic, and Treatment allows professionals to assess youth for early signs of substances use issues.

Because over 90% of adults with chemical dependency issues began use under age 18 and approximately 50% under the age of 15, CHIP is striving to catch substance abuse before it spirals out of control. In an effort to do this, CHIP provides coverage for select in-patient/residential treatment facilities and detox, along with family-based treatment approaches.

Some of the outpatient treatment interventions typically covered by CHIP include:

  • Individual therapy addressing psycho-social stress, personal issues and teaching coping skills.
  • Group therapy to use the power of peer support for healing and life direction changes.
  • Family therapy options.
  • Partial Hospitalization, or “day treatment”  options.
  • Case management for long-term care.
  • Medication management, psychiatrist visits and similar services.

Prior Authorization

Prior authorization refers to approval by Medicaid that a particular service is a medical necessity. The rules for prior authorization vary depending on which state you’re in and which type of Medicaid plan you have. For substance abuse, the identified patient must be assessed in order to determine what type and intensity of program is medically needed to address the addiction. Then, Medicaid determines how much they will cover based on this assessment.

Out-of-pocket Expenses to Expect in Rehab

This refers to how much you’ll owe of your own money, in addition to what Medicaid pays. In general, some out-of-pocket expenses apply to every Medicaid insurance holder except for those exempted by law. Those with exemptions include persons under the age of 18, terminally sick persons and persons living in an institution. Since Medicaid addresses the needs of low-income families and extremely sick persons, a professional can’t withhold services for the inability to pay, but Medicaid holders can be held accountable for unpaid co-payments.

Questions and Concerns

It is important to know that any Medicaid coverage is determined by your specific qualifications, as well as knowing which facilities accept Medicaid.  Adrugrehab.org can help you navigate your options, out-of-pocket expenses, and restrictions. We offer a wide array of useful information regarding Medicaid coverage for drug and alcohol interventions.

If you need help understanding exactly what your policy covers, receiving resources to help you overcome financial barriers, or finding the best choice of treatment available, call to speak with our professional team of licensed counselors, here to support you with our free, confidential helpline.