Medi-Cal is a Medicaid program in the state of California that provides free or low-cost health insurance to low-income families and individuals. Members who are qualified and dealing with alcohol or drug abuse can get substance use disorder (SUD) treatment at a Drug Medi-Cal approved center. Many Medi-Cal treatments, including those for drug abuse treatment, are made available through waiver programs.
Opioid Medicated Assisted Treatment (MAT)
California has implemented protocols that make buprenorphine more widely available throughout the state. Suboxone, a medicine used to treat opioid withdrawal symptoms and cravings, is composed of buprenorphine and naloxone. Most buprenorphine medicines no longer require a Treatment Authorization Request (TAR) or prior authorization from Medi-Cal; however, a DEA waiver and a diagnosis of opioid addiction are required to acquire the prescription.
Suboxone is an effective medicine for medically assisted treatment, and having better access to it in a timely manner might help someone get started on the path to recovery sooner.
OPTIONS FOR HEALTH COVERAGE
- EXPANDED MEDI-CAL- Modified Gross Adjusted Income (MAGI) is another name for Expanded Medi-Cal. The non-disabled, non-elderly, childless adult population up to 138 percent of the Federal Poverty Level is eligible (FPL). MAGI, or adjusted gross income as specified in household income tax returns, will be used to compute household income. For MAGI families, there will be no asset/property criteria.
- TRADITIONAL NON-EXPANDED MEDI-CAL- The elderly, blind, and disabled, long-term care, medically needy, and people judged eligible for Medi-Cal as a consequence of other programs such as CalWORKs, Adoption Assistance Program, or foster care comprise the Non-Expanded Medi-Cal population. The asset/property criteria will continue to apply to non-expanded Medi-Cal eligibility.
- PRIVATE INSURANCE FROM THE EXCHANGE PLANS- Covered California, the state’s health insurance exchange, will provide four distinct health plan levels: platinum, gold, silver, and bronze. The four tiers differ in terms of premium cost and benefit level. All tiers give the bare minimum of coverage mandated by the Affordable Care Act. Advanced Premium Tax Credits (APTC) are offered to help families with modified adjusted gross incomes less than 400% of the FPL afford the cost of health insurance.
Inpatient Rehab Coverage
If you reside in a county that accepts the DMC-ODS waiver, you may be able to receive treatment in an inpatient drug rehab program. Short-term residential services, or those lasting up to 90 days, are required under the DMC-ODS criterion.
Outpatient Rehab Coverage
Depending on the county you reside in, if you have Medi-Cal coverage, you may be able to choose between outpatient treatments and intense outpatient services (commonly known as intensive outpatient programs or IOPS). IOPS requires greater time spent in treatment and more counseling and therapy sessions while yet allowing clients to work and live at home.
Substance Abuse Policy Coverage
California’s Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver modification was authorized by the federal government in 2015. The approval broadened services to cover more people and mandates that evidence-based procedures be more widely available for the treatment of SUDs. According to the California Health Care Foundation, the DMC-ODS is a project that will expand services such as “case management, withdrawal management, multiple levels of residential SUD treatment, physician consultation, recovery services, and the choice to provide medication-assisted treatment (MAT) and partial hospitalization.”
The Affordable Care Act (ACA) pledges that all Medicare health plans provide the following Essential Health Benefits (EHB):
- Outpatient services
- Emergency services
- Maternity and newborn care
- Prescription drugs
- Mental Health and Substance Use Disorder services
- Laboratory services
- Rehabilitative services and devices
- Preventative and wellness services and chronic disease management