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Addiction, or substance use disorder (SUD) affects the lives of millions of Americans in the general population. This includes people that are enrolled in the Medicaid program. Almost 12% of people over 18 who use Medicaid for their health insurance program have SUD.

What is Medicaid?

medicaid drug rehab

Medicaid is a health insurance program that is funded by the state and federal governments and it does offer coverage for SUD treatment. Medicaid is typically available to low-income people, depending on their eligibility. Eligibility requirements depend on their state of residence. In the State of Maine, Medicaid is known as MaineCare Insurance in Portland.

Who Is Eligible for Medicaid?

Medicaid provides healthcare coverage for over 72.5 million Americans. To take part in Medicaid, states are required by federal law to cover certain groups of people. To be eligible for Medicaid, people who apply must be one of the following and make less than 100% to 200% of the federal poverty level:

  • Over 65 years old
  • Under 19 years old
  • Disabled
  • Pregnant
  • Parent or caretaker of a child

MaineCare provides low-cost and free health insurance to Maine residents who meet certain eligibility requirements. These are based on:

  • Household composition
  • Household income

Each state has its own requirements for eligibility.

Can Veterans Get Medicaid?

If you’re a veteran and you’re not enrolled in VA benefits or any other health coverage for veterans, you can get coverage through the Health Insurance Marketplace. However, depending on your income and the size of your household, you may be able to get lower costs on monthly premiums and out-of-pocket expenses on private insurance. You may also qualify for low-cost or free coverage through Medicaid.

How Can I Apply for Medicaid?

People who are eligible for Medicaid can apply at any time through the federal health insurance marketplace or their state’s Medicaid website.

  • If you are a Maine resident, you can apply online through My Maine Connection
  • Download the MaineCare Application and mail it in
  • Go to one of the district offices and apply in person

To apply, you’ll need to provide documentation that meets the state requirements. These may include:

  • A driver’s license or birth certificate
  • Recent tax returns or pay stubs
  • Proof of current address
  • Bank statements
  • Medical records

States have 45 days to process your application. If the eligibility is related to a disability, 90 days is allowed.

Exceptions and Alternatives

Even if you are over the income limits, you might still qualify. And if you don’t qualify for Medicaid, you may still be eligible to receive financial help through the Health Insurance Marketplace. Every state has its own rules for eligibility.

Eligibility rules also change every year. If you were turned down in the past, it’s possible you might be eligible now. What about Medicare coverage? Medicare is available to Americans over the age of 65, regardless of income. Depending on their situation, it is available for certain individuals under 65.

What Does Medicaid Drug Rehab Cover?

medicaid drug rehab coverage Medicaid is the single largest payer for substance abuse and mental health treatment in the U.S. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires coverage for SUDs and mental health disorders to be equal to the coverage available for other medical conditions. This pertains to:

  • Coinsurance, copays, and out-of-pocket maximums
  • Limits on the number of inpatient days or outpatient visits that are covered
  • Use of care management tools
  • Criteria for deciding the medical necessity

The good news is that most Medicaid recipients don’t have copayments for addiction rehab and in the states that charge copays, there is an out-of-pocket maximum. Medicaid covers part or all of the following:

States can establish other costs such as copayments, coinsurance, and deductibles on most outpatient and inpatient benefits. The amounts charged will vary with each person’s income.

Does Medicaid Cover Mental Health Treatment?

Yes, the MHPAEA of 2008 also covers mental health treatment. Treatment for addiction and mental health disorders is referred to as behavioral health services in Portland, Maine.

Is There a Limit on Rehab Stays?

Medicaid does put limits on the amount of covered services per year in some of the treatment categories. For example:

  • Inpatient treatment programs are typically limited between 30 and 60 days, but some exceptions may apply
  • Individual and group therapy (outpatient or residential) is limited to 30 hours per week
  • Does not set limits for an intensive outpatient program in Portland, Maine regarding how long you can participate each year

Do Drug Rehabs Accept Medicaid?

If you’re concerned about finding SUD treatment rehabs that accept Medicaid, you’ll find that many drug rehabs accept Medicaid.  Casco Bay Recovery in Portland, Maine, is one rehab that accepts Medicaid.

Casco Bay Can Help You With Your Medicaid Coverage

medicaid addiction rehab Understanding the limits and specific details of your coverage can be confusing. Particularly since a lot of the details depend on your particular evaluation. Our staff at Casco Bay is experienced in dealing with Medicaid coverage and we know how to apply for authorizations, document treatment, and bill Medicaid for the appropriate services.

We will work with you to help things progress as smoothly as possible. You should be concentrating on your recovery, not the details of your insurance coverage. We have several levels of care including:

If you’re struggling with a co-occurring mental health issue, our dual diagnosis program in Portland, Maine can help you overcome both substance use and mental health disorders.

Casco Bay can also provide you with specific care programs such as:

If it isn’t convenient to travel to our Portland location, for whatever reason, we can also provide a telehealth program in Portland, Maine. We can answer your questions and offer many options. Contact us today.