Do Drug and Alcohol Rehab Centers Take Medicaid Insurance?

Who is Medicaid?

Medicaid is a joint federal and state program in the United States that provides access to healthcare coverage for low-income families and individuals. Created in 1965 under the Social Security Act and administered by the Centers for Medicare and Medicaid Services (CMS) at the federal level, state Medicaid programs must comply with federal guidelines.

The specific services from Medicaid vary by state, but they generally include the following:

Doctor visits
Hospital stays
Prescription drug coverage
Long-term care
Laboratory and diagnostic testing
Medical equipment and supplies
Home health services
Behavioral health services

The eligibility criteria for Medicaid can also vary by state, but some general guidelines apply nationwide. You must meet certain income and asset requirements to be eligible for Medicaid.¹ Specifically, you must have a household income at or below a certain percentage of the federal poverty level (FPL). The FPL is updated annually and varies depending on your household size and the state you live in.²

Additionally, you must not have too many assets, as Medicaid is intended to help those with limited financial resources. Asset limits also vary by state.

In addition to income and asset requirements, eligibility for Medicaid can be based on other factors, such as age, disability, pregnancy, and citizenship or immigration status. For example, some state Medicaid programs cover individuals with disabilities, regardless of income.

It's important to keep in mind that eligibility criteria can vary by state and that some states have Medicaid expansion under the Affordable Care Act (ACA) to cover more individuals.³ Under the ACA, states can expand Medicaid eligibility to include adults with incomes up to 138% of the FPL, regardless of age, disability, or other factors. As of 2021, 38 states and the District of Columbia have expanded Medicaid eligibility. This number is expected to rise in mid-2023.⁴

What is Rehab Insurance Coverage?

Rehab insurance coverage is the amount a health insurance policy will pay for services like addiction treatment and other types of therapy or counseling that are part of the recovery process. The type of insurance policy, the particular rehabilitation treatments required, and other factors can impact the coverage level.

The cost of rehabilitation services can be high, especially if they are necessary for a long time. By providing rehab insurance coverage, insured people can better manage these expenses and access the medical attention they require to recover from disease, accident, or addiction.

Does Medicaid Cover Rehab for Substance Abuse?

Under the Medicaid program, drug and alcohol rehab treatment is typically covered under behavioral health services.⁵ These services may have specific limitations, such as the number of days or sessions covered, but they usually include outpatient and inpatient care, detoxification, counseling, and medication-assisted treatment. Call 866-461-3339 to determine the details and limitations of your state's Medicaid program.

Check Your Health Insurance for Addiction Treatment

You can check your health insurance coverage levels for drug or alcohol addiction rehab by calling us on 866-461-3339 or by using the form below. Our admissions coordinators will interact directly with health on your behalf, removing from your shoulders the burden of figuring out if your insurance will pay for your addiction treatment.

Does Medicaid Cover Mental Health Rehab?

In the US, Medicaid is the largest payer for mental health care.¹ Under the Medicaid program, mental health services are considered a part of essential health benefits and are therefore covered. However, the extent of coverage and limitations can vary by state, so it's best to call 866-461-3339 to determine the specifics of your Medicaid reimbursement.

Medicaid services for mental health rehab may include inpatient and outpatient care, psychotherapy such as cognitive-behavioral therapy, dual diagnosis, aftercare, medication management, support groups, and other services.

Inpatient and Outpatient Rehab Centers That Take MedicAid Insurance

Virtue Recovery Center has been saving individuals from drug and alcohol abuse and restoring families for years with multiple accredited treatment locations in several states. You can contact our rehab centers at 866-461-3339 to determine if they accept Medicaid health insurance.

How Much Does Rehab Cost With Medicaid Insurance?

The average cost of inpatient rehab with Medicaid can vary depending on several factors, including the state where you live, your specific Medicaid plan, and the type of treatment you need. In general, Medicaid is designed to make rehab services more affordable and accessible to those who need them, including inpatient care.

According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), the average cost of inpatient treatment for substance use disorders was $16,104 per stay in 2018.² However, the actual cost of inpatient rehab with Medicaid can vary widely. In some cases, Medicaid may cover the total cost of rehab services, while in other cases, you may be responsible for copayments or a portion of the treatment cost.

How To Check Medicaid Coverage Levels for Rehab Treatment

The best way to verify insurance details is by filling out our no-obligation online form or calling us at 866-461-3339. We’ll contact Medicaid directly and call you as soon as possible to review your policy details and discuss the next steps. Virtue Recovery Centers guarantees to keep any information exchanged entirely confidential.

How To Get Medicaid To Pay For Rehab Treatment

The process of getting Medicaid to pay for rehab treatment can vary depending on your specific Medicaid plan and the state you live in. To get Medicaid addiction treatment coverage, you’ll need to follow certain steps and meet certain criteria. Below are some general steps you can take:

Check your Medicaid coverage: First, you must ensure that your plan covers rehab treatment. Call 866-461-3339 – Virtue Recovery Center can handle this for you.
Get a diagnosis: You will need a diagnosis of a substance use disorder or a mental health condition to be eligible for rehab treatment. A healthcare provider, such as a doctor or a therapist, can typically provide a diagnosis.
Find a rehab provider: You will need to find rehabs that accept Medicaid. You can search for providers on your state Medicaid agency's website or by dialing 866-461-3339 for more information about Virtue Recovery Center’s treatment facilities.
Get a referral: You may need a referral from your primary care provider or a specialist to receive rehab treatment. This can depend on your specific Medicaid plan and the type of treatment you need.
Get prior authorization: Your Medicaid plan may require prior authorization for rehab treatment. This means you must get approval from your Medicaid provider before receiving treatment. Again, Virtue Recovery Center can assist with this step.

Attend treatment: Once you have met all the requirements, attend your rehab treatment program as your healthcare provider recommends.

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How Many Times Will Medicaid Pay For Rehab?

The number of times that Medicaid will pay for rehab treatment can vary depending on your specific Medicaid plan and your state. Generally, Medicaid will cover rehab treatment as often as medically necessary to treat your substance use disorder or mental health condition.

The duration of coverage and the number of treatment sessions covered will depend on the severity of your condition and the treatment plan recommended by your healthcare provider. In some cases, Medicaid may only cover a certain number of days or sessions of treatment per year, while in other cases, Medicaid may cover an unlimited number of sessions.

Medicaid Rehab Treatment and Insurance Statistics

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), Medicaid is the largest payer for substance abuse treatment in the US, covering approximately 21% of all substance abuse treatment costs.
Nearly 12% of Medicaid beneficiaries over 18 have a substance use disorder.¹
The 51 states that provided statistics on Medicaid enrollment for October 2019 reported that 64,699,741 people were enrolled in Medicaid.²
The average Medicaid spending in 2017 for adults 20-64 was $5,159 per beneficiary.
When asked if they received required care, 56% of persons enrolled in Medicaid said, "Always."
Overall, 58% of addiction treatment centers reported accepting Medicaid as payment. However, only approximately half of those programs claimed to have a doctor on staff, although 42% of the treatment programs were situated in areas where billing for Medicaid required that a doctor be involved in the treatment planning process.³
Medicaid coverage for methadone increased from thirty-three to forty state plans, representing the highest coverage increases for medications after the Affordable Care Act (ACA) implementation.⁴
Approximately two million non-elderly individuals in the US had an opioid use disorder in 2017, and about four out of ten of these adults were insured by Medicaid.⁵

Non-elderly persons with opioid use disorder were more likely to obtain treatment in 2017 with Medicaid than other insurance.

Check Your Medicaid Insurance Coverage With Virtue Recovery Center

If you’re committed to recovery, submit a request to one of our professional admission coordinators today using the form below. Before discussing the next steps, a coordinator will address any inquiries regarding our programs, including interacting directly with your Magellan on your behalf to check your insurance coverage levels for drug or alcohol addiction rehab.

STEP 1

Using your Health Insurance Card, fill out all of the fields on the confidential form.

STEP 2

A member of our staff will contact your insurer to verify if your policy will cover your treatment

STEP 3

We will contact you promptly with the results of the verification and discuss the next steps

*Insurance Disclaimer: Virtue Recovery Center will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note that this is only a quote of benefits and/or authorization. We cannot guarantee that payment or verification eligibility will be accurate and complete as conveyed by your health insurance provider. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service. Your health insurance company will only pay for services it determines to be “reasonable and necessary.” Virtue Recovery Center will make every effort to have all services preauthorized by your health insurance company. Suppose your health insurance company determines that a particular service is not reasonable and necessary or that a specific service is not covered under your plan. In that case, your insurer will deny payment for that service, and it will become your responsibility.

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Name of Patient

Date of Birth of Patient*

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*Insurance Disclaimer: Virtue Recovery Center will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Virtue Recovery Center will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

Related Rehab and Insurance Resources

Sources and Citations

Centers for Medicare & Medicaid Services. “Medicaid Eligibility.” Medicaid, www.medicaid.gov/medicaid/eligibility/index.html. Accessed 18 Apr. 2023.
“Federal Poverty Level (FPL) - Glossary.” HealthCare.gov, www.healthcare.gov/glossary/federal-poverty-level-fpl.
“Medicaid Expansion and What It Means for You.” HealthCare.gov, www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you.
Norris, Louise. “Medicaid Expansion, Eligibility, Enrollment and Benefits in Your State.” healthinsurance.org, Apr. 2023, www.healthinsurance.org/medicaid/#adopted.
Centers for Medicare & Medicaid Services. “Behavioral Health Services.” Medicaid, www.medicaid.gov/medicaid/benefits/behavioral-health-services/index.html. Accessed 18 Apr. 2023.
“Behavioral Health in Medicaid Program--People, Use and Expenditures : MACPAC.” MACPAC, 7 Oct. 2019, www.macpac.gov/publication/behavioral-health-in-medicaid-program-people-use-and-expenditures.
“National Survey of Substance Abuse Treatment Services (N-SSATS): 2018, Data on Substance Abuse Treatment Facilities.” Substance Abuse and Mental Health Services Administration (SAMHSA), 16 Sept. 2019, www.samhsa.gov/data/report/national-survey-substance-abuse-treatment-services-n-ssats-2018-data-substance-abuse.
Centers for Medicare & Medicaid Services. “Substance Use Disorders.” Medicaid, www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders/index.html. Accessed 18 Apr. 2023.
U.S. Centers for Medicare & Medicaid Services. “December 2022 Medicaid and CHIP Enrollment Data Highlights.” Medicaid, 2019, www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.
Andrews, Christina M., et al. “Do Benefits Restrictions Limit Medicaid Acceptance in Addiction Treatment? Results From a National Study.” Journal of Substance Abuse Treatment, 1 Apr. 2018, www.jsatjournal.com/article/S0740-5472(17)30431-2/fulltext.
Andrews, Christina M., Colleen M. Grogan, Bikki Tran Smith, et al. “Medicaid Benefits for Addiction Treatment Expanded After Implementation of the Affordable Care Act.” Health Affairs, vol. 37, no. 8, Project HOPE, Aug. 2018, pp. 1216–22. https://doi.org/10.1377/hlthaff.2018.0272.
Orgera, Kendal, and Jennifer Tolbert. “The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment.” KFF, 24 May 2019, www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/view/footnotes.