The 2010 Affordable Care Act (ACA) or Obamacare specifies that Insurance providers in the United States, such as Medicaid, should cover all the essential elements of alcohol and drug rehab. All health insurance providers in healthcare marketplaces or under government entities are required to cover behavioral health services.
Fortunately, addiction rehab services fall within that spectrum. The Substance Abuse and Mental Health Services Administration (SAMHSA) Directory can offer you insight on recovery providers accepting this insurance cover as a form of payment.
Medicaid is an insurance program partly funded by the federal government. It is also provided in each state. The primary function of this insurance program is to give healthcare access to eligible and low-income individuals who cannot otherwise afford health services. The Affordable Care Act specifies further that Medicaid must cover certain addiction treatment services, which include:
- General health examinations to ascertain the person’s health status and how their addiction is affecting it. This also includes diagnoses for substance use disorders.
- Testing for any drugs or alcohol in the user’s system in cases involving addiction treatment
- Emergency hospital stays and interventions
- Outpatient and inpatient addiction treatment services in certified rehab facilities that accept Medicaid coverage
- Family counseling if it is relevant to the treatment program
- Medication to address withdrawal symptoms, prevent drug cravings and ensure the whole rehab process goes comfortably and safely.
- Medically-supervised detox
- Other related dual-diagnosis services
Medicaid can also cover crisis intervention, case management, and counseling relevant to substance abuse disorders in other states.
Medicaid Eligibility
Medicaid does not simply cover Vicodin addiction treatment services for everyone; you have to meet specific criteria to qualify for this insurance coverage. Some people might not have health coverage currently, but they’re still eligible for Medicaid services, especially if they have recently experienced a reduction in their income. The exact details of one’s eligibility will rely on their state of residence, whether they meet the state’s eligibility requirements or at least one of the below qualifications:
- The person must be a parent or pregnant
- The individual should be younger than 19 years of age
- The individual should be older than 65 years of age
Certain states will offer Medicaid coverage for adults who meet their state’s income qualifications, including adults who fall below a specific income level or those receiving Supplemental Security Income. The Affordable Care Act mandates that individuals who make below 133% of the federal poverty level qualify for Medicaid coverage. Some people who live above the poverty level can still qualify for this health insurance if they are within the required income bracket.
However, note that each state has its laws on Medicaid eligibility, even if you meet the income requirements. In most states, individuals with Medicaid coverage will not have co-payments regarding addiction treatment.
States that charge Medicaid beneficiaries co-payments usually have a set maximum amount for out-of-pocket payments. States can set other costs such as deductibles and coinsurance on some outpatient and inpatient treatment benefits. The amounts charged can differ based on the individual’s income.
However, as much as Medicaid can cover drug addiction treatment, it is not accepted by all rehabilitation facilities as a means of payment for services. In that case, looking for a treatment facility that takes Medicaid is better if you are seeking Vicodin addiction treatment.
If you opt for a rehab care provider that does not accept Medicaid coverage, you will be charged for the addiction treatment services you’ve received. This is if you agreed beforehand to pay for the care costs with the knowledge that your insurance coverage would not pay for it. So this is essential to keep in mind before enrolling in a Vicodin addiction treatment program.
Medicaid Coverage Limits For Rehab Treatment
Medicaid has a cap on the amount of addiction treatment services it can cover annually for each healthcare category. For inpatient treatment programs, the limit usually falls between 30 and 60 days, but there can be exceptions to this number in some states if necessary.
Group and individual therapy, be it in an outpatient or inpatient rehab setting, is typically restricted to 30 hours weekly. On the other hand, Medicaid health coverage does not have restrictions for intensive outpatient program participation concerning the duration of treatment attended within a year.
Applying for Medicaid
Individuals who meet the requirements for Medicaid coverage for Vicodin addiction treatment can apply for it anytime via the state’s Medicaid website or the health insurance marketplace. To apply for this health cover, you must have the necessary documentation to meet your state’s Medicaid eligibility requirements. The documents required include:
- Your medical records from your current physician
- Bank statements
- Proof of your current residential address
- Recent tax returns or pay stubs
- Your driver’s license or birth certificate for identification services
The state usually takes 45 days to process Medicaid applications, but if your eligibility is regarding a disability, it can take 90 days. Individuals who fail to qualify can be eligible for subsidized plans offered through the federal Marketplace when there is open enrollment.
It can be challenging to understand the exact details and benefit limits of Medicaid coverage for addiction treatment. This is because the information usually varies depending on the individual’s specific case and diagnosis.
Fortunately, the staff in these rehab facilities is generally well-versed in dealing with all matters regarding insurance health plan coverage. They typically have an understanding of applying for authorizations, the documents required to apply, and billing the services needed. They can work with each patient every step to make sure everything goes smoothly with insurance policy payments so they can concentrate solely on recovery.