Medicaid is one of the most important resources for individuals seeking addiction treatment, offering coverage for various levels of care. However, many people are unsure what services are covered and what limitations exist under Medicaid drug rehab programs.
Understanding what Medicaid pays for and what out-of-pocket costs may apply can help individuals and families make informed decisions about treatment.
Does Medicaid Cover Drug Rehab?
Yes, Medicaid covers substance use disorder treatment as part of its essential health benefits. This means that individuals enrolled in Medicaid can access various levels of care, including detox, inpatient rehab, outpatient programs, and mental health support.
However, coverage varies by state, and some programs may require prior authorization or have specific provider networks that patients must use.
What’s Covered Under Medicaid for Drug Rehab?
Medicaid provides comprehensive coverage for addiction treatment, including:
Detoxification Services
For individuals experiencing withdrawal symptoms, Medicaid covers medically supervised detox, which provides:
- 24/7 medical monitoring to ensure safety
- Medications to ease withdrawal symptoms (such as Suboxone for opioid withdrawal)
- Transition planning into ongoing treatment programs
Inpatient and Residential Rehab
Medicaid covers inpatient rehab programs for those who require round-the-clock support. This includes:
- Medically monitored residential treatment
- Behavioral therapy and counseling
- Medication-assisted treatment (MAT) in residential settings
Outpatient Treatment
For individuals who do not need 24-hour care, Medicaid provides coverage for outpatient rehab, including:
- Partial Hospitalization Programs (PHP) – Intensive treatment while living at home
- Intensive Outpatient Programs (IOP) – Structured therapy a few times per week
- Standard outpatient therapy – Regular counseling sessions for ongoing support
Medication-Assisted Treatment (MAT)
Medicaid covers FDA-approved medications to help individuals manage cravings and withdrawal symptoms, including:
- Methadone and buprenorphine for opioid use disorder
- Naltrexone (Vivitrol) to block the effects of opioids or alcohol
- Acamprosate and disulfiram to reduce alcohol dependence
MAT is most effective when combined with behavioral therapy, which is also covered under Medicaid.
Behavioral Therapy and Mental Health Treatment
Since many individuals with addiction also struggle with co-occurring mental health disorders, Medicaid includes coverage for:
- Cognitive Behavioral Therapy (CBT) and other evidence-based counseling
- Dual diagnosis treatment for individuals with substance use and mental health conditions
- Psychiatric care and medication management
By integrating addiction treatment with mental health support, Medicaid ensures that individuals receive comprehensive care for long-term recovery.
What Medicaid Does Not Cover for Drug Rehab
While Medicaid covers a wide range of treatment services, there are limitations to what it will pay for. Some common exclusions include:
Luxury or Private Rehab Facilities
Medicaid only covers state-approved treatment centers, which means that private, luxury, or high-end rehab facilities may not be included.
Out-of-Network Providers
Medicaid typically requires individuals to use approved providers within its network. Treatment at out-of-network rehab centers may not be covered unless prior authorization is obtained.
Certain Holistic or Alternative Treatments
Some rehab programs offer alternative therapies such as yoga, acupuncture, and equine therapy. While these treatments may be beneficial, Medicaid does not typically cover them unless they are part of an approved treatment plan.
Extended Residential Treatment Beyond State Limits
Most Medicaid programs have limits on the length of stay in inpatient rehab. While short-term and long-term programs are covered, individuals may need re-authorization for extended stays beyond state limits.
How to Use Medicaid for Drug Rehab
For individuals seeking Medicaid-covered addiction treatment, the process involves verifying coverage and finding an approved provider.
1. Check Medicaid Eligibility
To qualify for Medicaid, individuals must meet income and residency requirements in their state. Ohio residents can check eligibility through the Ohio Department of Medicaid website.
2. Find a Medicaid-Approved Rehab Facility
Not all treatment centers accept Medicaid. Individuals can use:
- The SAMHSA treatment locator tool to find Medicaid-covered rehab centers
- State-funded addiction treatment resources
- Assistance from Ohio Community Health, which helps verify coverage
3. Obtain Prior Authorization if Needed
Some Medicaid services, such as residential treatment or medication-assisted treatment, may require prior approval. This involves:
- Getting a referral from a healthcare provider
- Submitting necessary documentation for approval
- Working with a treatment center to complete the authorization process
4. Begin Treatment with Medicaid Assistance
Once approved, individuals can begin their Medicaid-covered treatment plan, which may include detox, therapy, medication management, and outpatient care.
How Ohio Community Health Helps Medicaid Patients
At Ohio Community Health, we believe that financial barriers should never prevent someone from receiving the treatment they need. We work with individuals to:
- Verify Medicaid eligibility and coverage for addiction treatment
- Find the right treatment program based on medical and financial needs
- Assist with prior authorization and paperwork for Medicaid-covered services
By providing comprehensive, Medicaid-approved addiction treatment, we ensure that individuals receive the care they need at little to no cost.
Start Your Recovery Journey Today
Medicaid provides crucial access to drug rehab services, covering everything from detox and inpatient care to outpatient therapy and medication-assisted treatment. Understanding what’s covered and what’s not can help individuals take the next step toward affordable, life-saving addiction treatment.
If you or a loved one needs Medicaid-covered drug rehab in Ohio, contact Ohio Community Health Recovery Centers today. Our team can verify your coverage, explain your treatment options, and help you begin your recovery journey.
Ben Lemmon, LCDCIII
Reviewed on 02/18/2025
