Medicaid is an integral part of healthcare coverage in the United States. Every state has its own eligibility guidelines. If you have a mental health condition that has led to addiction treatment, Medicaid could be a vital resource for getting the help you need. One of the biggest challenges keeping people from seeking addiction treatment is coverage or financial restraints. However, many don’t know that Medicaid does pay for substance abuse treatment if a person is eligible for the program.

Understanding Medicaid

Medicaid is a government program that provides health insurance coverage to families and individuals who can’t afford private insurance. More than 70 million people are enrolled in Medicaid, making it the nation’s largest public health insurance program. You may qualify for Medicaid coverage if your income falls below a certain level or you have limited formal education.

Does Medicaid Pay for Rehab?

Treatment for drug addiction is covered under most state Medicaid plans, but coverage can vary from state to state. Treatment in a rehab facility can be covered if considered medically necessary. This means you need to suffer from a condition that affects your ability to work or attend school and requires medical treatment.

In general, Medicaid does not cover long-term inpatient treatment for substance abuse disorders. However, a few states have recently modified the program to provide limited coverage for residential treatment facilities in some circumstances.

Still, treatment for alcohol and drug addiction is one of the nine essential health benefits that Medicaid programs must provide under the Mental Health Parity Act of 1996.

What Type of Addiction Services Are Covered

Treatment for substance abuse disorders is covered under the Essential Health Benefit category of “Behavioral Health Treatment Services.” The services must be medically necessary and rendered by a provider within or outside the program’s network.

Treatment options include:

  • Traditional outpatient programs – These outpatient centers provide counseling, support, group meetings, therapy sessions, and other activities.     
  • Intensive outpatient programs – Intensive outpatient programs are more structured than traditional ones and provide clients with more guidance. This includes attending support groups regularly.    
  • Day treatment facilities – Day treatment facilities offer counseling and support during the day while clients work or attend school at night. These facilities allow clients to attend school or work while still receiving treatment as an outpatient. 

Other services that Medicaid may cover include screenings, interventions, maintenance medications, family counseling, and other mental health services. However, you must check with your local Medicaid office since each state’s coverage is different. 

Who Is Eligible for Medicaid?

Medicaid is a joint federal and state program, with each state having its own eligibility criteria and regulations. The basic qualifications to be eligible for Medicaid are:

  • Being over 65 years old or under 19 years old
  • Pregnant
  • Being a parent
  • Or, being within a specified income bracket 

Eligibility often depends on income level, family size, and disability status, among other factors. Income eligibility levels are generally based on the federal poverty level (FPL).

To qualify for Medicaid, a family’s income must fall below 133 percent of the federal poverty, currently $16,642 for a one-person household. The federal government pays for about 60 percent of Medicaid expenses, with the remainder funded by the state.

Finding Rehabs That Take Medicaid

Finding a rehab center that takes Medicaid can be complicated. Those who qualify for Medicaid may be able to get in-patient or outpatient rehab for free or at a very low cost. It’s important to note that because individual states run the Medicaid program, each state has different laws regarding eligibility and coverage.

In most cases, you can find a quality program that accepts Medicaid in your area, even if it’s not necessarily located in the same city or state. You may have to complete a Medicaid application process if you find one. As far as the application process is concerned, it’s extremely important to apply for Medicaid assistance before entering treatment. You may need to submit some paperwork or even attend an interview before being approved. 

If you or a loved one is seeking substance abuse treatment, our team can help you learn more about Medicaid eligibility and how to apply. We can help you fill out the paperwork and call us to confirm your enrollment.