Does Medicaid Cover Drug Rehab?

The cost of rehab is a major barrier that can prevent people from seeking the treatment they need to overcome addiction. However, rehab is covered by insurance, and depending on the details of your plan and the treatment center you choose, you may be able to get treatment at little to no cost.

Medicaid is a type of insurance that will cover drug and alcohol rehab at select addiction treatment facilities. In this article, you will learn:

• What is Medicaid
• Who is eligible for Medicaid
• Medicaid drug and alcohol rehab coverage
• How to verify your insurance

What is Medicaid?

Medicaid is a type of health care plan that provides affordable health insurance coverage to low-income individuals, including adults, children, and people with disabilities. Medicaid plans are overseen by individual states and must adhere to federal guidelines, but they are funded by both the state and federal governments. As a result, Medicaid coverage and plan details can vary from one state to another.

Medicaid is not the same as Medicare, which provides coverage for seniors and those with disabilities. Medicaid eligibility depends primarily on income brackets and poverty levels.

In January 2024, more than 84 million Americans were enrolled in a Medicaid health plan.[1] It is the largest payer of behavioral health services in the United States.[2] By providing affordable coverage to low-income populations and providing extensive mental health coverage, Medicaid is an essential service that can help people get the treatment they deserve.

Who is Eligible?

The 2010 Affordable Care Act (ACA) officially expanded Medicaid coverage to all low-income adults who are under the age of 65.[3] Other people who may qualify for Medicaid include:

• Pregnant women
• Children
• People who receive Social Security Income (SSI)
• Children in foster care who are not eligible for community-based services

Each state has their own eligibility requirements for Medicaid coverage. This eligibility is influenced greatly by the federal poverty levels in the state. In 2024, the federal poverty levels and income brackets in Florida are as follows:[4]

• $15,060 for one person
• $20,440 for two people
• $25,820 for three people
• $31,200 for four people
• $36,580 for five people
• $41,960 for six people

States that have expanded Medicaid allow people who earn 138% above the poverty level to qualify for Medicaid coverage. However, Florida is one of 10 states that have not expanded Medicaid under the ACA, so income limits are low compared to some other states.

Does Medicaid Cover Drug and Alcohol Rehab?

Yes, Medicaid health plans cover drug and alcohol addiction treatment services.

The Affordable Care Act (ACA) and other healthcare legislation such as the Mental Health Parity and Addiction Equity Act (MHPAEA) require both private and public insurance plans to provide coverage for mental health and substance abuse issues. These laws ensure that Americans do not face discrimination when seeking treatment for addiction or mental illness. Federal guidelines require Medicaid health plans to meet parity requirements so their addiction treatment coverage is no less restrictive than it is for other medical conditions.

Research has found that approximately 12% of people enrolled in Medicaid have a substance use disorder.[5]

Medicaid is a very large payer of substance abuse treatment services in the United States. In 2021, 71% of drug and alcohol rehab centers accepted Medicaid health plans.[6]

While Medicaid addiction treatment coverage is guaranteed, there are limitations to this coverage. Inpatient treatment programs are typically limited to 30-60 days until coverage stops. Individual and group therapy, on both an inpatient or outpatient basis, is limited to 30 hours a week. However, Medicaid does not set limits on an IOP.

Addiction Treatment Services Covered by Medicaid

At detox centers and substance abuse treatment facilities that accept Medicaid, affordable treatment can be obtained by those who are enrolled. Services covered include:

• Complete health screenings including a mental health assessment and substance abuse evaluation
• Drug and alcohol testing
• Emergency hospital stays
• Inpatient or residential treatment
• Medical detox
• Treatment medications
• Partial hospitalization programs (PHPs)
• Intensive outpatient programs (IOPs)
• Outpatient programs (OPs)
• Dual diagnosis treatment services
• Group, individual, and family therapy

Insurance may not cover alternative or complementary treatments, such as chiropractic, acupuncture, massage, sober living homes, and more. Be sure to speak with your insurance provider to understand the limitations of your coverage.

Does Archstone Behavioral Health Accept Medicaid?

Archstone Behavioral Health is in-network with several Medicaid plans, including Humana Florida Medicaid, Clear Alliance Medicaid, and Simply Healthcare Medicaid. If you have Medicaid in Florida or another in-network plan, our Lantana, FL addiction treatment center may accept your insurance, making treatment available to you at little to no cost. Your coverage may vary depending on the level of care you attend and the exact details of your insurance plan.

Verify Your Coverage Today

If you are enrolled in a Medicaid program and are struggling with addiction, please reach out to Archstone Behavioral Health today. We accept a range of Medicaid health insurance programs and can help you understand your benefits, verify your coverage, and make arrangements for admissions. Contact us now to get started!

References:

1. Medicaid: January 2024 Medicaid & CHIP Enrollment Data Highlights
2. National Center for Drug Abuse Statistics (NCDAS): Average Cost of Drug Rehab
3. National Conference of State Legislatures: Medicaid and the Affordable Care Act
4. Hillsborough County Florida: Determine Eligibility
5. Medicaid: Behavioral Health Services
6. Substance Abuse and Mental Health Services Administration (SAMHSA): National Survey of Substance Abuse Treatment Services