Many people believe that they can’t seek treatment for alcohol abuse or addiction because they can’t afford it. While the cost of addiction treatment is certainly not cheap, there are many options available to help supplement the out-of-pocket expenses of a rehab program. One of the most popular options to help pay for treatment is through public or private insurance. Using Medicaid for alcohol rehab treatment may be easier than you think
What Is Medicaid?
Medicaid is a federally funded public insurance provider for low-income families. While coverage varies from state to state, a Medicaid insurance plan will cover at least some of the costs for alcohol addiction treatment.
Medicaid coverage is available regardless of any pre-existing conditions. This is because the Affordable Care Act requires all insurance companies – including public insurance carriers such as Medicaid – to offer coverage to all those eligible despite pre-existing conditions such as addiction. Additionally, under the 2010 ACA, insurance providers (including Medicaid) are required to cover all basic aspects of a drug and alcohol recovery program.
Each state may require additional eligibility requirements as to who can qualify for Medicaid, so it’s important to check with your state’s guidelines.
In order to be eligible to receive Medicaid coverage, you must be one of the following:
- over 65
- under 19
- within a specific income bracket
- a parent
Some states will provide Medicaid coverage for any adult that is below a certain income bracket. For example, if a one-person family makes no more than $15,654, he or she may be eligible for Medicaid despite his or her age. Additionally, if an individual is receiving Social Security Income, he or she may automatically be eligible for Medicaid coverage.
Prior Authorization Requirements For Medicaid Insurance Plans
Some states will require you to seek prior authorization for certain treatment services before Medicaid will pay for the services rendered. For example, some states may require individuals to try outpatient alcohol addiction treatment before Medicaid will cover inpatient treatment. Each state is different, so it’s important to check first with your insurance to determine what is required for a particular treatment.
In-Network Vs. Out-Of-Network Coverage
The alcohol addiction rehab facility you choose to attend must be in-network in order for Medicaid to cover the treatment services. If you are unsure if a treatment facility accepts Medicaid, it’s best to call ahead to prevent unwanted costs. All state-funded rehab facilities accept Medicaid.
Does Medicaid Cover Alcohol Detox Programs?
Most states require Medicaid to cover an inpatient medically-supervised detox program. Many people require a medically supervised detox program when withdrawing from alcohol due to the dangerous side effects that can arise during the withdrawal process. A detox program provides the medical support and care needed to ensure a safe and effective withdrawal from alcohol.
Medicaid Coverage For Inpatient Rehab Treatment
Medicaid will cover up to 60 days of inpatient alcohol addiction treatment as well as any medications administered during treatment. This type of treatment is most commonly recommended to those with serious alcohol use disorders.
Both inpatient detox programs, inpatient treatment programs, and long-term residential care for alcohol addiction are covered under Medicaid. Most states do not require a copay for Medicaid recipients, but it’s important to check before choosing a treatment facility to attend.
Outpatient Addiction Programs Covered By Medicaid
There are many different types of outpatient alcohol addiction treatment, with the most common being intensive outpatient programs, often referred to as IOP. IOP is a less intensive form of treatment than inpatient programs but still provides a high level of structure and care. Many states do not require a copay for outpatient addiction programs for those with Medicaid.
Other outpatient rehab programs include:
- Individual and Family Counseling — Many people choose to seek therapy either during or after treatment for alcohol addiction. Therapy is typically in either individual or group format, but family and couples’ are also a popular form of counseling when dealing with addiction. Therapy allows individuals to talk through their feelings and experiences and work on ways to cope with sobriety.
- Medication-Assisted Treatment (MAT)— Medication is administered for a variety of reasons throughout treatment for an alcohol use disorder. Medicaid will cover medication that is used at clinics or during an intervention as well as medication used to manage mental health disorders for those suffering from co-occurring disorders. There are many dual diagnosis treatment centers that accept Medicaid.
- Partial Hospitalization Programs — Partial hospitalization programs are the most intensive form of outpatient treatment available. They require the patient to attend treatment each day for several hours a day and return home in the evenings.
- Standard Outpatient Programs— Standard outpatient programs can vary in the treatment approach, but most center around group or individual therapy.
Each program varies in its level of intensity, and Medicaid may not cover all outpatient rehab programs. If Medicaid does cover a particular outpatient service, most states will not require you to pay a copay to receive Medicaid coverage. If you are required to pay a copay, many states enforce an annual out-of-pocket maximum, so you will only pay so much for medical treatment.
Identifying Your Medicaid Insurance Coverage
Fully understanding your Medicaid insurance coverage is the first step toward getting the treatment you need and deserve for an alcohol use disorder. Additionally, calling ahead to ensure the facility you plan on attending accepts Medicaid is also important to preventing excess or unknown costs.
To learn more about using your Medicaid insurance coverage for alcohol abuse and addiction treatment, contact us today.