Medicaid Coverage for Addiction Treatment

The following items may be used to determine eligibility for Medicaid:³

• Financial eligibility: You must meet the financial requirements which may be determined by your Modified Adjusted Gross Income (MAGI). Some individuals are exempt like those eligible based on disability or age (65 and older).
• Citizenship and residency: Medicaid beneficiaries must generally be residents of the state in which they are receiving benefits and must either be a citizen of the United States or be a qualified non-citizen.

Yes, Medicaid typically pays at least some part of drug and alcohol rehab treatment. State insurance typically covers rehab for most individuals. While Medicaid often covers substance use disorder (SUD) treatment, Medicaid addiction treatment coverage is also highly dependent on individual state policies. Additionally, Medicaid rehab coverage may vary depending on your insurance plan. The costs associated with SUD treatment may vary between Medicaid health insurance members by state.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in-network or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol rehab treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

Medicaid addiction treatment coverage is now accepted at many substance abuse treatment facilities across the country. Again, Medicaid may or may not pay your full rehab treatment costs, but it can make treatment more affordable at rehab facilities that accept Medicaid.⁴ Coverage may include:

• Detox
• Addiction Intervention
• Screenings
• Inpatient and outpatient care
• Mental health services

Typically, you will have no co-payment for drug and alcohol treatment. However, some states do require a co-pay. There will be a maximum co-pay that cannot be exceeded.

Additionally, Medicaid can also be a valuable asset for those who do not have private insurance, as it can allow them to access free or low-cost rehab centers. While everybody will find their costs to be different, Medicaid can help keep the cost of treatment low for low-income individuals.

Types of Substance Use Treatment That Medicaid Covers

With most Medicaid plans covering at least some of the costs of rehab treatment for drug and alcohol addiction, the types of treatment and the rehab process can vary in intensity and frequency. Types of treatment may include:^{7, 8}

Detox Programs: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable or even life-threatening. Medical detox helps you safely withdraw from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You may also be given medications to help minimize withdrawal symptoms.

Residential Care or Inpatient Treatment Centers: Inpatient/residential treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs. Medicaid may cover residential treatment depending on the length of the treatment program.

Partial Hospitalization Programs (PHP): Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.

Intensive Outpatient Program (IOP): Intensive outpatient programs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and even go to work during the day.

Outpatient Treatment Facilities: Individuals who have completed inpatient rehab treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

Many people wonder if inpatient rehab vs. outpatient rehab or another type of treatment is best for them. When you decide to get treatment for drug or alcohol addiction, you can work with your healthcare provider to determine the right continuum of care based on your needs and preferences.

In most cases, you will need to seek drug and alcohol treatment at a rehab facility that is in-network with Medicaid to receive your full benefits. Even if you choose a treatment center that is in-network, you may still be responsible for some of the treatment costs.

If you choose a facility that is out-of-network, you may be responsible for all the costs of your substance abuse treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the facility.

Before choosing the right addiction treatment center for you, check your Medicaid policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your health insurance card or log in to your account on Medicaid’s website to learn more about what your specific policy plan covers.

Knowing exactly what your Medicaid plan covers can give you peace of mind while you or your loved one is in drug and alcohol rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles.

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the rehabilitation center, the type of program attended, and specific services received. When you sign up, Medicaid will send you information about your health coverage along with a directory of rehab facilities that work with Medicaid. You can also verify your insurance benefits online or call the phone number on your insurance card.

To find state-specific coverage, visit your state’s official website. Log in and verify your coverage to find your details. You can also call American Addiction Centers and speak to one of our admissions navigators at . They can provide you with information about addiction treatment coverage and answer any questions you have.

Before deciding on a rehab center, check your Medicaid policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Medicaid’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the rehab facility you are considering accepts Medicaid. Or call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.

If your Medicaid insurance policy does not cover all your rehab treatment expenses, it’s important not to let that stop you from getting treatment for drug and alcohol abuse. You don’t have to use the insurance when you decide to check into a substance abuse treatment facility.

Make sure to do thorough research when looking for a rehab center so that you can find one that meets your financial needs. Find out how much your Medicaid plan covers before you enter drug and alcohol rehab. Your coverage depends on your treatment needs, so you should talk to your rehab facility for more information.

There are also other ways to finance your treatment and get the help you need. Some ways to pay for addiction rehabilitation include:

• Payment plans: You pay off rehab in affordable installments.
• Sliding scale: The rehab center decreases your cost to something you can reasonably afford—typically based on your income level.
• Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehab facilities, offer grants and scholarships to pay for people who can’t afford substance abuse treatment.
• Purchase affordable insurance on the Healthcare Marketplace.
• Open a healthcare credit card or take out a specialized healthcare loan.
• Use your savings or a credit card.

Here are additional resources that provide more information about other ways to pay for drug and alcohol rehab treatment with or beyond what Medicaid covers:

• How to Pay for Rehab Without Insurance
• FAQs about Paying for Rehab
• What is the Cost of Drug Rehab?

Medicaid makes it possible for many people to afford addiction treatment by making it affordable for those with low incomes. Your coverage may change based on where you go for treatment and where you live. Go online or talk to an AAC admissions navigator by calling to ask how we can help you get the treatment you need.

• Does Health Insurance Cover Rehab?
• How To Get Into Rehab Without Insurance
• How To Pay For Rehab Without Insurance
• Alcohol Rehab Without Insurance
• Does Insurance Cover Sober Living?
• Dual Diagnosis Treatment Centers That Accept Insurance
• Does Medicaid Pay For Rehab?
• Financial Assistance for Addiction Rehab
• Does Insurance Cover Suboxone?
• Does VA Cover Inpatient Rehab?
• State Funded Rehab Near Me
• Free Drug and Alcohol Rehab Near Me
• Affordable Rehab Centers Near Me

1. Medicaid.gov. (n.d.) Benefits.
2. Medicare.gov. (n.d.) Medicaid.
3. Medicaid.gov. (n.d.) Eligibility.
4. Medicaid.gov. (n.d.) Behavioral Health Services.
5. U.S. Department of Health & Human Services. (2021). Mental Health and Substance Use Insurance Help.
6. Centers for Medicare and Medicaid Services. (2018.) Medicare and Medicaid Basics.
7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
8. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
9. American Council on Aging. (2022). Medicaid By State: Alternative Names and Contact Information.