Does Medicaid Cover Drug Rehab?

If you’re struggling with addiction and worried about how to pay for treatment, you’re not alone. Many people in Colorado rely on Medicaid to access the care they need. The good news is that Medicaid does cover drug rehab services at facilities like Recover Colorado and those benefits have expanded significantly in recent years.

Since January 2021, Health First Colorado (the state’s Medicaid program) has provided comprehensive coverage for substance use disorder treatment. This means you can get help without the financial burden that once kept so many people from seeking recovery.

What Medicaid Covers for Substance Abuse Treatment

Medicaid covers a wide range of addiction treatment services. These options include:

• Medical detox
• Inpatient rehab
• Outpatient rehab
• Medication-Assisted Treatment (MAT)
• Individual counseling and behavioral therapy
• Group counseling and behavioral therapy
• Continuing care

Medical Detox

You can access medical detox, which helps your body safely withdraw from drugs or alcohol under professional supervision. This is often the first step in recovery, and it’s critical because withdrawal can be dangerous without medical support.

Inpatient, Outpatient, and MAT

Beyond detox, Medicaid pays for inpatient rehabilitation programs where you live at a treatment facility while receiving intensive care. You’ll also find coverage for outpatient programs, which let you attend therapy and counseling while living at home. 

Medication-assisted treatment (MAT) is another covered service. MAT uses FDA-approved medications to reduce cravings and withdrawal symptoms, making it easier to focus on your recovery.

Counseling and Behavioral Therapy 

Counseling and behavioral therapy are essential parts of treatment, and Medicaid covers both individual and group sessions. If you’re dealing with both addiction and a mental health condition like depression or anxiety, dual diagnosis treatment is available, too. Medicaid even covers continuing care services, which provide ongoing support after you complete a formal program.

What to Expect During the Medicaid Approval Process

The Medicaid approval process follows a pattern, which includes:

• Contacting a facility
• Verifying coverage
• Receive approval
• Start treatment

Start by contacting a Medicaid-approved treatment facility. The facility will verify your coverage and may need to submit additional paperwork to Medicaid for approval. This process can take a few days, though some facilities can expedite it in urgent situations.

You might need to provide documentation about your substance use history, previous treatment attempts, and current health status. This information helps Medicaid determine which level of care is medically necessary for you. Beyond the financial verification, many people find it helpful to understand what happens during the rehab admissions process to feel more prepared for their first day.

When Medicaid May Not Cover Certain Treatments

Medicaid doesn’t cover everything. Luxury rehab facilities with resort-like amenities typically don’t accept Medicaid. Out-of-network providers usually aren’t covered either, so you need to verify that a facility accepts Medicaid before you start treatment.

Some experimental or alternative treatments may not be covered if they’re not considered medically necessary. Medicaid also won’t pay for services you receive without proper authorization or a referral.

Coverage can vary by state, and optional services are determined at the state level. If you move to a different state, your coverage might change.

How to Appeal a Denied Medicaid Claim

If Medicaid denies coverage for a service you believe should be covered, you have the right to appeal. Start by requesting a written explanation of the denial. This document will explain why your claim was rejected and outline the appeals process.

Contact your Medicaid case manager or the customer service number on your card to begin the appeal. You’ll need to submit additional documentation supporting your need for the denied service. This might include letters from your doctor, treatment records, or evidence that the service is medically necessary.

The appeals process can take several weeks, so start as soon as possible. If your initial appeal is denied, you may have the option to request a hearing with an administrative law judge.