Does Medicaid Cover Heroin Addiction Treatment?

Medicaid is one of the biggest payers covering recovery services and substance abuse treatment in the US. Many people are always looking for heroin addiction treatment with Medicaid health insurance. Fortunately, it covers up to 40 percent of individuals suffering from opioid use disorder, and there are more states offering access to Medicaid due to the Affordable Care Act.

All the Medicaid programs in different states across the country provide coverage for addiction treatment services, including:

  • Mental health services, e.g., counseling and therapy
  • Outpatient rehabilitation, e.g., intensive outpatient programs and partial hospitalization programs
  • Detoxification
  • Long-term residential treatment
  • Inpatient rehabilitation
  • Medications for managing withdrawal and cravings
  • Intervention
  • Initial screening

Services Covered by Medicaid

All the Medicaid programs offered by different states cover substance abuse treatment and mental health services such as:

  • Peer support
  • Social work services
  • Medication management
  • Therapy
  • Counseling

Heroin Addiction TreatmentMost people suffering from substance abuse disorders also have co-occurring mental health conditions such as mood disorders, PTSD, depression, and anxiety. Substance use disorders and co-occurring health conditions must be treated simultaneously as they can affect each other. That is why affected individuals should select a rehab facility offering heroin addiction treatment and mental health care.

According to the Affordable Care Act, substance abuse disorder is one of the ten aspects of essential health benefits that insurers have to provide. That is why all US insurance providers (Medicaid included) have to cover mental health treatment and care. This mandate covers both mental health services and rehab treatment. The cost amounts that Medicaid covers usually differ in each state. Fortunately, you can also contact Medicaid directly to ask about specific coverage details or directly reach out to potential rehab facilities so they can confirm the benefits you can access.

How Long Can Medicaid Cover Heroin Addiction Treatment?

Heroin Addiction TreatmentThe rehab duration that Medicaid covers typically varies. Overall, Medicaid has a cap on the annual coverage amounts for each treatment category. Inpatient treatment, for example, can be restricted to a specific number of days each year. However, the treatment duration usually depends on the particular patient’s needs. Typically, inpatient rehab facilities admit patients for 15 to 90 days, but this will also depend on the person’s needs. The duration of treatment is usually long-term to help promote long-term sobriety and prevent relapse.

You can check your Medicaid plan details by calling the contact on your insurance card or directly reaching out to the rehab facility so they can check your benefits on your behalf. Even though Medicaid provides a lot of information on their websites for substance abuse disorder treatment, you can also speak to a representative to answer all your questions. They can also direct you to a heroin addiction treatment facility that takes Medicaid. The Substance Abuse and Mental Health Services Administration (SAMHSA) website and information hotline can also give you insight into rehab treatment facilities that accept Medicaid.

Eligibility for Medicaid Sponsored Rehab Treatment

The following factors will be taken into consideration to determine if an individual is eligible for Medicaid:

  • Residency and citizenship: Generally, Medicaid beneficiaries should be residents of the specific state where they are getting benefits, and they have to either be qualified non-citizens or US citizens.
  • Financial eligibility: The individual must meet specific financial requirements, which can be ascertained by one’s Modified Adjusted Gross Income or MAGI. Certain people can be exempt from this, including those who qualify for eligibility through age or disability.

Treatment Services Covered by Medicaid

Most Medicaid plans will take care of the costs of addiction treatment services depending on the rehab process and the types of treatment, which can differ in frequency and intensity. The different forms of heroin addiction treatment services covered include:

Detox Programs

Some people might need extra help to detox off alcohol and drugs like heroin, as this process can be dangerous and uncomfortable. Medically managed detox is the best way for people going through heroin addiction treatment to withdraw safely from the drugs. This also includes 24-hour medical supervision, including medication to help alleviate the withdrawal symptoms.

Inpatient Treatment and Residential Care

Residential/inpatient treatment facilities offer substance abuse disorder treatment while staying onsite. Inpatient treatment programs typically go for 15 to 90 days, depending on your personal needs and your program. Medicaid can cover inpatient treatment based on the duration of the treatment.

Partial Hospitalization Programs

These programs allow you to stay at home as you go through the treatment during the day.

Intensive Outpatient Programs

This involves going to treatment programs for several evenings every week while staying at home and attending to other responsibilities during the day.

Outpatient Treatment

Heroin Addiction TreatmentPeople who have gone through inpatient heroin addiction treatment usually take outpatient treatment for continuing support during their recovery journey. During outpatient programs, the patient can stay at home and go to the treatment facility for 10 to 12 hours weekly for the necessary support and therapy services. Most people are usually curious about whether outpatient or inpatient rehabilitation is best for treating substance abuse disorders. If this is on your mind, you can work with a healthcare provider to find the best model of addiction treatment, depending on your preferences and needs.

Before selecting an appropriate heroin addiction treatment facility, check your exact Medicaid plan benefits to see which costs will be covered out-of-pocket and the insurance provider. When you know what your Medicaid plan covers specifically, you will have peace of mind during rehab treatment. This will also allow you to focus solely on recovery and long-lasting sobriety without worrying about the financial aspect or any unexpected costs.