Medicaid

Does Medicaid Cover Rehab?

What Is Medicaid?

Medicaid is a public health insurance program that provides eligible individuals access to certain health care services. It is administered by each state independently along with assistance from the federal government. Each state determines their own programs as well as the type, amount, duration, and scope of services, within federal guidelines. In most cases, Medicaid will cover most or the entire cost of drug or alcohol rehabilitation and treatment, including rehab.

Who Is Eligible For Medicaid?

Medicaid, along with its Children’s Health Insurance Program (CHIP), provides health coverage for over 72.5 million Americans. In order to participate in Medicaid, federal law requires states to cover certain groups of individuals such as low-income families and people with disabilities. In order to be eligible for Medicaid, those who apply must be one of the following and make less than 100-200% of the federal poverty level (FPL):

• Over 65 years old
• Under 19 years old
• Pregnant
• Disabled
• Parent/caretaker of a child

In certain states, Medicaid covers all adults below a certain income level but rules for eligibility and treatment change annually. Income eligibility is determined by a person’s modified adjusted gross income (MAGI), which is the taxable income, plus certain deductions such as non-taxable Social Security benefits, individual retirement contributions and tax-exempt interest. In most states, a person’s MAGI is very similar to their adjust taxable income, which can be found on their tax return.

How To Apply For Medicaid

Those who are eligible for Medicaid can apply at any time through their state’s Medicaid website or the federal health insurance marketplace. In order to apply a person must provide appropriate documentation that meets the state’s requirements. These documents can include:

• A birth certificate or driver’s license
• Recent pay subs or tax returns
• Proof of current address
• Bank statements
• Medical records

States have 45 days to process an application and 90 days if the eligibility is in relation to a disability. Those who don’t qualify may be eligible for a subsidized plan through the federal Marketplace during open enrollment.

Medicaid For Drug And Alcohol Rehab

Medicaid is the single largest payer for mental health and substance abuse in the United States. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is a federal law that requires coverage for mental health and substance use disorders to be no more restrictive than coverage that is generally available for other medical conditions. This applies to:

• Copays, coinsurance, and out-of-pocket maximums
• Limitations of services utilization (ex: limits on the number of inpatient days or outpatient visits that are covered)
  
• Use of care management tools
• Criteria for medical necessity determinations

According to the Medicaid government website, about 12% of Medicaid beneficiaries over 18 have a substance use disorder (SUD). Fortunately, most Medicaid recipients don’t have co-payments for addiction treatment and in states that charge co-payments, there is an out-of-pocket maximum. Medicaid covers all or part of the following services:

• Screenings
• Intervention
• Maintenance therapy and medications
• Family Counseling
• Detox
• Outpatient care
• Inpatient care
  
• Long-term residential treatment

States can impose other costs such as copayments, coinsurance, and deductibles on most inpatient and outpatient benefits and the amounts charged vary with each individual’s income.

How To Find A Rehab Program That Accepts Medicaid

Figuring out how to pay for addiction treatment can be frustrating and complicated. Medicaid can help cover the cost of services such as detox, medication, and rehabilitation. Contact a treatment provider  for more information.