As a result of 2009’s Affordable Care Act, treatment for substance use disorders is widely available with government health insurance programs. Medicaid offers low-cost or free addiction treatment to individuals who need it most.
Addiction is an all-consuming disease that rewires the brain and often prevents people from being able to earn money or gain skills.
What’s more, people who struggle with substance abuse are often from less privileged socioeconomic backgrounds. As such, millions were previously missing out on behavioral health care services because they couldn’t afford insurance. Read on to find out everything you need to know about Medicaid and rehab.
Does Kentucky Medicaid Cover Drug Rehab?
Medicaid is a low-cost health insurance program that’s operated by the U.S. Government. It’s available to low-income individuals and families. While the Affordable Care Act necessitates that all insurance providers cover core rehabilitation services for people suffering from drug or alcohol addiction, not all private treatment facilities are obligated to accept Medicaid.
In many instances, the best care is available at private alcohol and drug rehabilitation centers that accept Medicaid. This is because they receive more funding than publicly operated rehab facilities. As such, you’ll usually have access to more treatment modalities, top-notch health care professionals and customized care.
Let’s take a look at some of the services included in Medicaid insurance coverage:
- Screenings for SUDs
- Family intervention
- Detoxification
- Medications such as methadone
- Inpatient care
- Outpatient care
- Substance abuse, mental health and family counseling services
Who’s Eligible for Medicaid Behavioral Health and Mental Health Services?
Medicaid provides treatment coverage to over 72 million Americans, making it the largest provider of subsidized health care in the country. According to federal law, all states are required to cover low-income families and individuals with disabilities. To apply, you need to earn less than 100% to 200% of the federal poverty level and meet one of the following criteria:
- Under 19
- Over 65
- Have a disability
- Pregnant
- Parent or guardian of a child
In some states, all adults who earn less than a specified amount have access to Medicaid, although this has the potential to change each year.
Applying for Medicaid
If you’re eligible for Medicaid, you can apply through your state’s Medicaid website at any time. You’ll need to gather the necessary documentation to meet your state’s requirements, which might include:
- Medical records
- Proof of address
- Recent tax returns or pay subs
- A driver’s license or birth certificate
- Bank statements
All states have 45 days to process your application, although this goes up to 90 days if you have a disability. If you’re not eligible for Medicaid but have a low income, you might be eligible for a subsidized health care plan using the federal marketplace.
Spend Down
Spending down isn’t available in all states, and there are some additional restrictions that determine eligibility. This process involves subtracting medical expenses from your income and using this adjusted amount to calculate eligibility. If you’re below a certain income level and already spending a significant amount on health care, you’re considered medically needy and therefore entitled to use spend-down rules.
Mental Health Parity
There are federal laws in place that prevent insurance companies from exorbitant deductibles and co-pays that would drive up the cost of rehab programs specifically. This parity law exists to ensure treatment for addiction is equal to behavioral and mental health treatment services.
Parity laws are pretty complicated, but the main reason they’re relevant here is because they prevent Medicaid from hitting you with large co-pays that only relate to substance abuse treatment.
You’re still expected to pay the co-pays that a health care plan would normally add on, but you can’t be penalized for having a substance use disorder.
Does the Medicaid Program Have Limitations?
Each state implements its own specific limitations with regard to the income boundary for eligibility. These limits are necessary to ensure coverage is only offered to individuals and families who need it most. Medicaid uses modified adjusted gross income, which is your earnings after adding in tax-based deductions and interests. In most instances, an individual must earn less than $2,349 to qualify.
What’s the Difference Between Medicaid and Medicare?
Medicare is a separate program that’s specifically for U.S. citizens aged over 65 and people with disabilities. It’s not a free service, but it offers significant discounts to qualifying individuals. There are four Medicare plans, and each covers a different aspect of treatment for drug and alcohol abuse.
- Part A: You pay a premium that entitles you to a deductible for each benefit period. It covers inpatient rehab, with up to 60 days in a facility without coinsurance. Medicare only pays for a maximum of 190 days of residential care in a person’s lifetime.
- Part B: Outpatient services are included in Part B, and premiums might be dependent on income. It might cover you for drug counseling services, outpatient rehab and treatment for co-occurring disorders such as anxiety, depression and bipolar disorder.
- Part C: You can opt into Part C if you’re interested in expanding the capabilities of your policy, but you should be aware that you’re responsible for co-pays, deductibles and out-of-pocket costs.
- Part D: This is another type of opt-in private insurance that includes prescription medication. If you require prescription meds to manage mental health problems or withdrawal symptoms, you’ll need Part D.
Dual Eligibility
Some people are entitled to Medicaid and Medicare, and they’re known as dual eligibles. If you fall into this category, there’s a good chance you’ll pay nothing or next-to-nothing for substance abuse treatment.
Paying for Drug Addiction Health Services Using Health Coverage From the Federal Government
After applying for Medicaid services, you’ll need to wait for approval before booking a space with the treatment provider of your choice. Once approved, a card you can show to treatment providers is sent to you by mail. If you don’t qualify for Medicaid, there are state-operated rehab programs that you can access for little to no cost.
Substance Abuse Services and Medicaid Coverage
Let’s take a detailed look at some of the alcohol and drug abuse treatment services covered by Medicaid.
Detox
Drug and alcohol detox is a medical necessity for many individuals who struggle with addiction. During this process, the body is purged of harmful chemicals and toxins to prepare for therapy and treatment. All psychoactive substances cloud judgment and impair thinking in one way or another, so treatment should only take place once you’ve gone through withdrawal.
Many people are scared of withdrawal symptoms, to the extent that they’ll continue using drugs instead of seeking treatment. Rehab is the best place to go through withdrawal because you have access to around-the-clock support from a team of health care professionals. What’s more, you can get MAT to ease cravings and discomfort and make the process as comfortable as possible.
Residential Treatment
Residential rehab is often seen as the most intensive form of rehab because it totally removes you from your current situation. This provides you with a chance to hit the reset button and make a fresh start as you continue the healthy, constructive routine that’s implemented during treatment. You’re removed from temptation and potential triggers and stay in an environment that’s specifically designed to support recovery.
At inpatient rehab, you take part in one-on-one counseling, group therapy and health-promoting activities and learn the importance of structure and routine for recovery. You enjoy three healthy meals a day and take part in regular, fun exercise to learn how crucial lifestyle is for remaining sober.
Partial Hospitalization Program
A PHP is the step down from inpatient rehab, and it’s practically the same apart from the fact you sleep at home instead of at the facility. Clients usually spend five days a week or more attending the clinic all day, where they take part in individual therapy and group counseling. For some people, living in a different facility isn’t possible, and a PHP offers these people access to the intensive level of care available at residential rehab.
Intensive Outpatient Programs
An IOP is the step down from a PHP, and it’s an ideal first step for individuals who struggle with a moderate to severe substance use disorder. It’s also a good idea for individuals who’ve recently completed a residential program or PHP and are looking to continue care at a slightly reduced intensity. You might spend three hours per day at an IOP three to five days a week, which leaves time to seek meaningful employment or gain skills through training or education.
General Outpatient Treatment
General outpatient treatment is the least intensive form of addiction treatment, making it the perfect choice for individuals with mild to moderate substance use disorders. It also serves as a step down from residential, PHP or IOP treatment, ensuring you don’t go straight from the highly structured environment of rehab back into daily life. GOP clinics usually take place for a few hours once or twice a week.
Family Counseling
Many experts call addiction a family disease because it has the potential to break down boundaries and communication and destroy relationships. Luckily, it’s unlikely relationships with the family members closest to you are beyond repair. In most cases, family therapy is required to educate your loved ones about substance use disorders and facilitate healthy communication between all parties.
Medication
Medicaid covers medication that’s deemed essential to your care in some instances. This might be MAT such as buprenorphine or methadone to relieve the symptoms associated with withdrawal, or medications to help you with mental health symptoms such as depression and anxiety. Buprenorphine is a semi-synthetic opioid compound that works by attaching to opioid receptors, tricking the body into thinking it’s received a hit of illicit drugs without making you high. Over time, you gradually ease off this medication until you’re completely free from substances.
Mental Health Services
In some cases, you might get a dual diagnosis, which means you have addiction alongside a co-occurring mental health disorder. While drugs can influence whether someone displays symptoms of depression and anxiety, many people use substances to relieve these types of symptoms.
To heal from both types of illness, you’ll need to seek mental health treatment, find the root cause of why you’re abusing drugs or alcohol and learn new coping mechanisms. Medicaid will cover mental health services in some cases, provided it’s an essential factor of your treatment for substance abuse.
How to Choose the Right Rehab Center
When deciding which treatment center to attend, there are several questions you should ask while conducting research. Let’s take a look at some of the most important ones:
- Do you accept Medicaid?
- Do you offer detox?
- Which addictions do you treat?
- What types of qualifications do the staff have?
- Is medication assisted treatment available?
- How long do the programs last? (The longer the better!)
- Which counseling and therapy modalities are offered?
- Are holistic therapies such as yoga, nutritional counseling and meditation available?
- What should I bring to rehab?
- What aftercare provisions are in place?
- Do you accept federal health insurance such as Medicaid and Medicare?
Substance Abuse Treatment Could Change Your Life
If money is the main reason you’re hesitant about seeking treatment services at drug and alcohol rehab, you might be surprised by the payment options available to those in need. Call Brookside Treatment today at 606-342-7089 for more advice about paying for a treatment program with Medicaid.
