If you or someone close to you is struggling with addiction, looking up the costs of treatment can be overwhelming. Thankfully, there are ways that you can apply health insurance benefits to reduce the cost. But does Medi-Cal cover substance abuse treatment?
Federal Coverage
The Affordable Care Act requires all Medicare plans to cover basic health needs, including:
- Outpatient services
- Emergency services
- Hospitalization
- Prescription drugs
- Mental health and substance use disorder services
- Rehabilitative services
- Laboratory services
What is Medi-Cal?
Medi-Cal is the Medicaid program for the state of California. Low-income families and individuals can receive healthcare services through state-provided health insurance, including substance abuse treatment.
If you live in a DMC-ODS area where Drug Medi-Cal is available, Medi-Cal covers the following:
- Outpatient services
- Intensive inpatient services
- Residential treatment
- Withdrawal management
- Narcotic treatment services
- Partial hospitalization
- Medication-Assisted Treatment
Inpatient
Inpatient care is where you reside full-time at the treatment center and work on a full-time schedule of recovery services each day.
If you live in one of these areas, you may be eligible for coverage of inpatient programs for up to 90 days.
Outpatient
Outpatient care refers to intensive outpatient programs, partial hospitalization programs, and traditional outpatient programs. The main difference here is that you don’t have to reside at the treatment center full-time, so you have more flexibility to maintain a schedule, especially if you have to continue working or providing for a family while undergoing treatment.
If you live in one of these areas, you may be eligible for coverage of several types of outpatient programs, particularly intensive outpatient services where you are able to remain at home but participate in a part-time schedule condensed over the span of several weeks.
Detox
Detox services look different depending on the substances to which you are addicted. In general, the services are provided at the same facility where you receive inpatient care but can also be provided at a third-party facility if you are only participating in outpatient care.
For those who are struggling with opioid addiction or alcoholism, there are FDA-approved medications that are prescribed to help with withdrawal symptoms, particularly buprenorphine and naloxone. These have to be provided by a qualifying facility but can be covered by your plan if you live in a qualifying area.
If you live outside of a DMC-ODS area where drug Medi-Cal is not available, then Medi-Cal covers:
- Outpatient services
- Intensive outpatient treatment
- Narcotic treatment program services
If you do not live in a qualifying area but you still have Medi-Cal, you can receive coverage for traditional intensive outpatient programs or outpatient care as well as narcotic treatment program services, which extend to opioid medication-assisted treatment and other prescription medications needed as part of your detox services.
Drug Medi-Cal
Drug Medi-Cal is a specific treatment funding source that can be applied to cover the costs of substance abuse treatment for eligible medical members. Use of this funding source requires individuals to receive treatment from a certified program.
Since 2015, there has been approved expansion of services for individuals who need treatment for substance abuse disorders, including:
- Case management services
- Multiple levels of inpatient treatment
- Withdrawal management services
- Recovery services
- Physician consultations
- Medication-assisted treatment
- Partial hospitalization programs
Getting Treatment with Peninsula Health
If you are struggling with addiction, you can call our team to learn more about Medi-Cal coverage for substance abuse treatment. We can help you determine what level of coverage you have with your plan and how much you might be expected to pay out of pocket for drug rehab.
We understand how difficult it can be to verify benefits, figure out what is included in your plan, and what else you might have to pay for different levels of care. That is why we work hard to process your requests with minimal hassle, breaking down what your benefits are and what each level of care costs when applying your benefits.
Overall, federal law requires all healthcare providers cover the cost of basic mental health services including substance abuse treatment. So, does Medi-Cal cover substance abuse treatment? Yes, it does, but the extent of your coverage, how long it applies, and what you have to pay out of pocket is based on your individual plan.
Reach out to Peninsula Health Center today for help verifying your Medi-Cal coverage. Don’t wait to get help!
