The short answer is yes, Medicaid covers drug and alcohol rehab services. In fact, all insurance companies provided by government entities or via the health care marketplaces are required to provide coverage for behavioral health services. Addiction services are covered under that umbrella.
However, when it comes to whether or not Medicaid will cover rehab in a specific case, the answer is often “It depends.” Find out more about Medicaid and its role in paying for alcohol or drug rehab below.
And if you’re struggling with addiction and want help, don’t be afraid to reach out for assistance regardless of whether you’re covered by insurance or know if your policy will cover the services. Call New Day Recovery today or contact us online; we’ll work with you to help you understand your options for recovery, whether it’s with us or another provider.
What Is Medicaid?
Medicaid is a program partially sponsored by the federal government and administered by each individual state. The main purpose is to ensure low-income individuals and certain other qualifying individuals have access to health care coverage.
Medicaid is not the same thing as Medicare, although the two programs were created under the same initiative in the 1960s. The qualifications for these programs are slightly different. Medicare is primarily meant to provide coverage for seniors and those with disabilities. Another difference is that Medicare is administered by the federal government. Since the administration falls to the states, there are slight differences in how the coverage works depending on which state you live in or have coverage in.
In every state, though, Medicaid does offer some type of addiction treatment coverage.
What Types of Addiction Services Are Covered Under This Comprehensive Medical Insurance?
Under the Affordable Care Act and other health care legislation in the past few decades, Medicaid must offer coverage for certain services under the addiction treatment banner. Some services that may be covered by your comprehensive medical plan if you are diagnosed with a substance abuse disorder or addiction disorder are listed below.
- Health screenings to determine your current health status and how addiction may be impacting that, as well as to diagnose you with a substance abuse disorder
- Alcohol and drug testing in treatment-related cases
- Interventions, including emergency hospital stays
- Inpatient or outpatient rehab services within an approved facility that accepts this managed care program
- Family counseling if it’s deemed necessary to your treatment
- Addiction treatment medication to help you get through withdrawal periods safely and more comfortably or to address other needs with regard to substance abuse, including medications to stave off cravings
- Medically assisted detox
- Other dual diagnosis services that might be relevant to your diagnosis
Ohio Medicaid covers all of these types of treatment services. It also covers group or individual counseling, case management and crisis intervention relevant to drug or alcohol addiction treatment.
Who Is Eligible for Medicaid?
Whether Medicaid will cover drug rehab services for you individually obviously depends in part on whether you qualify for coverage. Even if you don’t have the health plan coverage right now, you may qualify for the services — especially if you recently lost your job or have experienced another reason for a reduction in income.
The specific details of eligibility depend on your state. Generally, you must meet at least one of the following and the state income requirements to be eligible:
- Be older than 65
- Be younger than 19
- Be pregnant or a parent
Some states do provide Medicaid for any adult meeting the income requirements for the state, though.
To qualify for Medicaid in the state of Ohio, you must be a resident of the state and have a “satisfactory immigration status” or be a US citizen. Other eligibility requirements for Ohio Medicaid are outlined below.
- Be older than 64 years of age
- Be disabled or blind or have a dependent in your house who is
- Be pregnant or have one or more children who are under the age of 18
- Have a household income before taxes that falls below the thresholds below
- One person: $16,612
- Two people: $22,491
- Three people: $28,369
- Four people: $34,248
- Five people: $40,127
- Six people: $46,005
- Seven people: $51,884
- Nine people: $57,762
Ohio Medicaid provides an easy-to-use eligibility checker you can use to better determine if you might be covered under the medical care program.
What Is Parity?
Parity refers to federal laws that forbid insurance companies from charging excessive copays and deductibles associated with specific types of health services when they don’t charge similar amounts for other types of services. One of the purposes of parity laws is to ensure that insurance companies provide equal coverage for behavioral health and substance abuse services.
While parity laws are complex, the short story here is that if you qualify under Medicaid for covered substance abuse services, Medicaid can’t penalize you with large copays that only relate to that type of service. That does not mean you won’t be responsible for copays that are normally passed on by the health care plan. You can learn more about potential copays and how they are managed via your state’s Medicaid program website. For example, Ohio Medicaid’s copays typically run between $1 and $3 per service, and you can find a detailed list of Medicaid copays here.
Do All Providers Accept a Managed Care Program?
Another factor in whether or not your Medicaid coverage pays for drug rehabilitation services is where you opt to receive those services. Not all providers accept assignment on the managed care programs benefits. If you choose a provider that doesn’t accept Medicaid, then you’ll be billed for the services provided (assuming you agreed in writing to be responsible for the cost of your care, knowing that the health care plan wasn’t going to pay for it).
New Day Recovery does accept Ohio Medicaid, so this is not a worry for anyone entering into our programs.
Are There Limits On This Health Plan Coverage of Rehab?
Yes, Medicaid puts limits on the amount of covered services per year in many categories of treatment. Inpatient treatments are typically capped at between 30 and 60 days, although Ohio Medicaid does make some exceptions when necessary. Individual and group therapy, whether it’s in a residential rehab environment or outpatient, is limited to 30 hours per week. However, this type of health plan coverage doesn’t set limits for participating in an intensive outpatient program with regard to how long you can take part each year.
Understanding benefit limits and the specific details of coverage can be difficult, especially since so many of these answers rely on the specifics of your diagnosis and case. The experienced staff at New Day Recovery is adept at dealing with this health plan coverage, and we understand how to apply for authorizations, provide and document appropriate treatment and bill them for the right services. We work with you to make the entire process as seamless as possible because our belief is that you should concentrate on recovery and not the minutia of insurance policies.
Can I Use This as a Secondary Insurance in Addition to Other Insurance Options?
In some cases, Medicaid may act as secondary insurance. This is primarily the case for seniors who have Medicare and also qualify for this secondary insurance coverage. This type of secondary insurance always acts as the payor of last resort. That means if you have another insurance policy, then it would pay first for any rehab services.
However, if you have copays or deductibles after your first insurance pays, then there is a chance that this health plan coverage may act as the secondary payer. It could cover all or part of those copays, reducing the cost of rehab for you.
What Should I Do if I Need Rehab Services?
Struggling with alcohol or drug addiction on your own is rarely a winning proposition. But fear of the unknown and worries about the financial impact of treatment often keep people from reaching out for help.
No matter what your current insurance situation is or whether you think you can afford treatment, don’t make this mistake. Call us today; our compassionate admissions counselors are always ready to take your call and listen to your story. We work with you to understand your needs so we can make the right referrals and recommendations for next steps.
Our staff is experienced in addiction treatment, and if your insurance won’t pay for rehab at New Day Recovery, we can offer referrals to programs that do accept your policies. If you’re struggling financially and don’t have coverage, we can help you apply for Medicaid or understand other options for paying for rehab.
The important thing to know is that you have options. No matter who you are or what your situation is. Ohio Medicaid is only one of the many options that can come into play, so call us even if you are certain you won’t qualify for that coverage. And never assume that you won’t qualify; eligibility information can be confusing, and you might be surprised to discover what type of assistance is available in paying for drug or alcohol addiction treatment.
Call us right now, or complete our online contact form. We’ll reach out and start the process of working with you to take the first steps in the healing process of recovery.