Does Medicaid Cover Drug Rehab? Get the Facts Here

Rehabilitation centers are frequently recommended for those looking to recover from a drug addiction. The treatment provided at rehab centers is extensive and includes a variety of programs including medical detoxification, group therapy, individualized therapy, family support programs, and more. 

As one can imagine, treatment does not come free and the cost of drug rehab can be staggering leaving families stuck between a rock and a hard place. It’s important to know what financial resources are available because you never want anything to get in the way of your recovery or the recovery of your loved one. 

Exploring Payment Options for Drug Rehab

The cost of rehab will vary based on the type of program and level of care needed. Residential treatment programs that provide the highest level of treatment and offer around-the-clock care are the most expensive. Outpatient treatment programs are less expensive but may not provide the level of care needed to sustain recovery. 

Although cost should not be a deterrent for picking the best rehabilitation option, it is something that almost every family needs to take into consideration and rehab centers are aware of that. The good news is that there are several payment options to explore, the first of which is your private health plan. 

If you have a private health plan, most will cover at least a portion (if not all) of the substance abuse treatment program. It’s best to call your health insurance company directly and ask what is covered. Be sure to ask about in-network and out-of-network benefits. 

If you’re not sure what to ask, you can work with the Beach House rehab treatment facility who will call your insurance company on your behalf to learn about coverage options. 

The four major health insurance companies, Blue Cross and Blue Shield, Aetna, Cigna, and United Healthcare, each provide coverage for substance abuse and mental health services. The level of coverage is typically dependent on your specific plan. 

Pre-existing Conditions and Affordable Health Care Act

The Affordable Health Care Act (frequently referred to as the Affordable Care Act or Obamacare) allows coverage for pre-existing conditions. This is good news for anyone dealing with a substance abuse issue. If you apply for insurance under the Affordable Care Act (ACA), you will not be penalized if you are already battling an addiction. You will be able to secure insurance. In fact, drug and alcohol disorders are among the ten disorders central to the ACA. This means that policies offered via the ACA must treat addiction and mental health disorders with the same level of care as other medical conditions and diseases. 

The amount of coverage provided will depend on the specific plan chosen. Plans offered by the ACA are categorized as Bronze, Silver, Gold, and Platinum. A bronze plan may pay close to 60 percent of a rehabilitation program whereas a platinum plan may pay up to 90 percent of a program. The plans will vary based on monthly premiums. 

Medicaid and Drug Rehab Coverage 

Another option to pay for substance abuse recovery programs is Medicaid. Medicaid is a federal- and state-funded program that provides healthcare to individuals who fall below a certain income level. Other factors that determine Medicaid eligibility include age, number of people in a household, and if anyone has a disability. 

According to Medicaid.gov, “Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services.” As substance abuse issues continue to rise in the United States, Congress enacts more laws to improve access to mental health and substance use disorder services. The most recent law, the Mental Health Parity and Addiction Equity Act (MHPAEA), impacts millions of Medicaid recipients. 

The MHPAEA requires that mental health and substance abuse disorders receive the care they need, and coverage is “to be no more restrictive than the coverage that generally is available for medical/surgical conditions” such as out-of-pocket maximums. For more information regarding MHPAEA, visit Behavioral Health Services on Medicaid’s website. 

As data continues to provide evidence that treatment for substance use disorders provides substantial cost savings for taxpayers, insurers, and families, there is no reason to expect behavioral health coverage to go away. 

The level of treatment provided by Medicaid as well as eligibility guidelines for Medicaid varies from state-to-state.

Medicaid covers all or part of the following services:

• Screenings
• Intervention
• Maintenance and craving medications
• Family counseling
• Inpatient rehab
• Long-term residential treatment
• Detox
• Outpatient visits
• Other mental health services

If you are unsure if you’ll qualify for Medicaid, it’s worth trying. Enrollment for Medicaid is open throughout the year meaning you can apply for coverage and begin Medicaid at any time of the year. You can apply online via the healthcare marketplace or you can apply in person via a local agency. 

Please note that not all drug rehab facilities accept Medicaid. Connect with an admissions counselor to find out your financial options.

The Cost of Not Pursuing Rehab

Although the costs of drug rehab might seem intense, the costs of not treating an addiction are much more severe and include long-term health problems like liver disease, memory problems, cancer, and potentially death. The staff at the Beach House Center for Recovery is committed to working with you, and finding a financial solution that works for you and your recovery needs. Contact us today