What You Need To Know about Medicaid Addiction Recovery Coverage

What is covered? As Medicaid.gov notes, the program is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. Opportunities for coverage are constantly evolving.

Most recently, the Mental Health Parity and Addiction Equity Act passed and extended Behavioral Health Services coverage to beneficiaries participating in Managed Care Organizations, State alternative benefit plans and the CHIP. Medicaid.gov provides comprehensive information about its Behavioral Health Services coverage for children and youth and others with substance abuse disorders.

What are the specifics of coverage in your state? Because some states accepted the expansion and some didn’t, you might be uncertain on whether you or your loved one qualifies. One way to determine eligibility is income level. If you’re an individual who makes less than $16,243/year, then you may qualify. You can also use the State Medicaid & CHIP Profiles map to find out if your state accepted the expansion, enrollment data, and how to apply.

Does Medicaid provide recommended treatments? Periodically, the Centers for Medicare and Medicaid Services (CMS) releases Informational Bulletins on effective practices for treating substance abuse disorders. Here are two examples:

●Medication Assisted Treatment for Substance Use Disorders

●Delivery Opportunities for Individuals with a Substance Use Disorder

How can you get substance abuse treatment for your child? Medicaid and CHIP do provide behavioral health services and substance use treatment coverage to children. The programs have released Informational Bulletins that explain the extent of this coverage:

●Coverage of Behavioral Health Services for Youth with Substance Use Disorders

●Dept. of Health and Human Services’ Federal Guidance Policy Letter on Trauma Screening

For additional information on getting the best substance abuse treatment for your child, the Partnership for Drug-Free Kids provides the Treatment eBook: How to Find the Right Help for Your Child with an Alcohol or Drug Problem.

What facilities accept Medicaid? To find a treatment facility, use the Substance Abuse and Mental Health Services Administration’s Treatment Services’ Locator. Each facility listed comes with information regarding the kinds of insurance it will accept.
Will Medicaid cover court-mandated rehab? The National Drug Court Institute’s Ensuring Sustainability for Drug Courts: An Overview of Funding Strategies explains that reimbursement has depended on the state in the past. Some states will reimburse court-ordered treatment; while in others, funds have been provided by local governments to the state to match federal Medicaid funds.

What if you or your loved one have too much income to qualify? If you or your loved one is under 21, over 65, disabled, or blind, or part of a family where one or both parents are absent, deceased, or unemployed, you may be able to “spend down” to qualify. The New York State Education Department explains that if someone has too much income to qualify for Medicaid, they may be able to get coverage through the program when they spend the excess income on medical bills.

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