Some people use Medicaid to pay for alcohol and drug rehabilitation services, which are covered by this state-funded health insurance program. This means that cocaine addiction treatment would fall under this category. However, when considering whether Medicaid covers rehab in certain cases, the answer will depend.
Defining Medicaid
The federal government partly funds this program to ensure specific qualifying and low-income individuals get healthcare coverage. Medicaid does cater to addiction treatment in every state.
Under healthcare legislation during recent decades, including the Affordable Care Act, Medicaid has to provide coverage for specific services that fall under addiction treatment, such as cocaine addiction treatment. Services that an inclusive medical healthcare plan can cover for individuals diagnosed with substance abuse or addiction order such as cocaine addiction include the following:
Relevant dual diagnosis services that are relevant to the individual’s condition- Medically supervised detox
- Addiction treatment medication to help the individual safely and comfortably manage withdrawal periods or deal with other needs related to their substance abuse. This includes medicines designed to keep drug cravings away.
- Family counseling, if it is considered relevant to cocaine addiction treatment.
- Outpatient or inpatient rehabilitation services in a certified treatment facility that accepts Medicaid
- Interventions and emergency hospital stays
- Drug and alcohol testing during addiction treatment.
- Health screening to ascertain the individual’s current health status and the effects of their addiction on that. This also includes diagnosing the individual with a substance abuse disorder in the first place.
Medicaid covers all these treatment services and crisis intervention, case management, and counseling (group and individual) related to cocaine addiction treatment.
Who Can Use Medicaid?
Medicaid covers drug rehab services if an individual qualifies to access the coverage. Even if one does not have coverage for their health plan, they can still be eligible to access the services. This is especially true for people who may have lost their jobs recently or gotten a decrease in their income for one reason or the other. The exact details of one’s eligibility for Medicaid will also depend on the individual state. Generally, one has to meet the state’s income requirements and at least one of the following qualifications to be eligible for Medicaid:
- Be a parent or pregnant
- Be younger than 19 years old
- Be older than 65 years old
Certain states offer Medicaid for adults who meet the state’s income requirements. In some states, you have to be a resident within the state and be a US citizen or have an acceptable immigration status to be eligible for Medicaid. Check for your eligibility status before using Medicaid for cocaine addiction treatment.
When considering whether your Medicaid health coverage provides for drug rehab services, think about the facility where you will get those treatment services. This is because not all service providers will take Medicaid for their services. So if you go to a provider that does not accept it, you will have to pay out of pocket for any services or treatment you received at that facility. This is if you agreed to pay for the cost of care in writing if you knew the health coverage would not provide for it.
Does Medicaid Have a Limit When Covering Addiction Treatment?
Medicaid does have a restriction on how much they can cover for treatment services every year. The coverage is usually restricted to 30 to 60 days for inpatient treatment facilities. However, Medicaid does make exceptions in some cases. The cap is limited to 30 hours weekly for group therapy and individual therapy, regardless of whether it is in an outpatient or inpatient treatment setting. On the other hand, Medicaid coverage does not have yearly duration restrictions for individuals in a comprehensive outpatient program.
It can be hard to understand the specific details and benefits limits for Medicaid coverage since most of this information is dependent on the specifics of your case and your exact diagnosis. The qualified staff in these addiction treatment facilities have experience handling Medicaid coverage, and they understand how to bill for the services provided. They work with each patient to ensure the process is as smooth as possible so they can focus on recovery.
Can You Use Medicaid as a Secondary Insurance Option?
Sometimes people will use Medicaid as an alternative insurance option. This is mostly true for seniors with Medicare who are also eligible for Medicaid as a secondary insurance coverage option. In such situations, secondary insurance is considered the last resort payer – meaning if the individual has an alternative insurance policy, it will pay off first for addiction rehab services.
On the other hand, if the person has deductibles or copays after the initial insurance pays, there is a likelihood that Medicaid can become the secondary payer. It may cover part or all the co-pays, which could decrease the individual’s rehabilitation cost.
People with a drug or alcohol addiction are usually already in a tricky situation without adding to the worry of the financial effects of the treatment. This mostly prevents them from asking for help from friends, loved ones, or qualified medical professionals. Regardless of the affected person’s insurance situation or ability to afford cocaine addiction treatment, it is still important to seek assistance.
Fortunately, you can speak to facility coordinators about payment methods and whether they accept Medicaid insurance for addiction treatment services. Many of them will be happy to listen to your situation and understand your needs to work with you and make recommendations or referrals for your next steps. Suppose one is experiencing financial struggles and lacks health coverage. In that case, they can even help you apply for Medicaid health coverage or understand any alternative payment options they have to attend rehab. Most importantly, keep in mind that you have options for cocaine addiction treatment regardless of your situation.