Medicaid is a government-run health care program Medicaid and Medicare are federal and state-funded health insurance programs or low-income households that are often used to pay for drug and alcohol treatment. Under the 2010 Affordable Care Act (ACA), often known as “Obamacare,” insurance providers (including Medicaid) are required to cover all fundamental components of drug and alcohol addiction rehabilitation. Although Medicaid supports drug addiction treatment, not all institutions accept Medicaid as payment. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) to locate a recovery provider who takes Medicaid.


Who is Eligible?

Each state has its own set of regulations for eligibility and treatment coverage. Eligibility rules are also subject to change on an annual basis. If you were previously denied Medicaid or Medicare, you might now be eligible. The following factors may be considered to assess Medicaid and Medicare eligibility.

  • Financial Eligibility: You must fulfill the financial criteria based on your Modified Adjusted Gross Income (MAGI). Some people are excluded, such as those who qualify due to disability or age (65 and older).
  • Citizenship and Residency: Medicaid recipients must generally be residents of the state in which they receive benefits and be either a US citizen or a qualified non-citizen.

Medicaid supports addiction treatment, but the amount of coverage varies depending on where you reside and your eligibility. Medicaid makes drug and alcohol rehab treatment more accessible by providing insurance to low-income persons who meet certain criteria. Medicaid supports all individuals under a specific income threshold in several states. Supplemental Security Income recipients are frequently automatically eligible for Medicaid. To be eligible for Medicaid under the ACA, persons must earn less than 133 percent of the federal poverty level (FPL). A person who earns more than the poverty line may still be eligible for government insurance if they fall into the appropriate income band.

What Does Medicaid Cover?

In most states, Medicaid beneficiaries do not have to pay co-payments for addiction treatment. There is an out-of-pocket limit established for Medicaid beneficiaries in states that impose co-payments. Long-term inpatient care, prescription medicines, and outpatient therapies are all covered under Medicaid for substance abuse treatment.

Medicaid pays for all or a portion of the following services:

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

Types of Treatments Covered:

  • Hospital Stay Insurance: Inpatient rehabilitation might be covered by Medicare Part A. Part A provides coverage for up to 60 days of treatment without the need for a co-insurance payment. People who use Part A must pay a deductible. Inpatient treatment is only covered by Medicare for 190 days in a person’s lifetime.
  • Medical Insurance: Part B may fund outpatient treatment for those who are addicted. Up to 80% of these expenditures are covered by Medicare Part B. Outpatient treatment, therapy, medicines supplied through clinics, and professional interventions are all covered under Part B. Part B also addresses the treatment of co-occurring illnesses such as depression.
  • Medicare-approved Private Insurance: Part C is an option for people who desire extra benefits from Medicare. Out-of-pocket expenses and coverage vary and may be more expensive.
  • Prescription Insurance: Addiction medicines can be covered through Medicare Part D. People in recovery frequently require medicine to control withdrawal symptoms and cravings. These medicines improve the chances of remaining sober.

How to Check Your Medicaid Rehab Coverage?

An individual may be qualified for both Medicaid and Medicare. If a person is eligible for both programs, they can use the benefits from both to pay for their treatment. Check your Medicaid policy benefits before selecting the right addiction treatment facility for you to decide which charges will be reimbursed by your insurance company and which will be out-of-pocket for you. To discover more about what your specific policy plan covers, call the number on the back of your health insurance card or log in to your account on Medicaid’s website.

Knowing exactly what your Medicaid plan covers might provide you with peace of mind while you or a loved one is in drug and alcohol rehabilitation. You can do the work of becoming sober without having to worry about unforeseen bills or financial difficulties.

If you currently have Medicaid or Medicare, you can use the SAMHSA website to identify a drug or alcohol recovery center. Contact a treatment provider for additional information on possible recovery alternatives.

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