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Does Medi-Cal Cover Drug Rehab?

Table of Contents

Medi-Cal does cover drug rehab. This insurance coverage is available for California residents with low-income levels and limited resources.

The ACA and Rehab Coverage

The Affordable Care Act (ACA) of 2010 expanded Medicaid services in many states, including California. Through the ACA, substance abuse treatment and mental health services fall under behavioral health care. They are considered to be “essential health benefits” that must be covered under federal and state-based health insurance coverage sold on the federal marketplace.

California’s version of Medicaid, Medi-Cal, provides health insurance coverage for California residents who may not have other options for health care. Low-income adults, children, seniors, families with dependent children, pregnant women, and individuals with disabilities may qualify for Medi-Cal services.

Parity laws ensure that as an essential health benefit, substance abuse treatment services are covered by Medi-Cal the same as other medical and surgical services. Medi-Cal can cover drug rehab through providers that accept it as a form of payment. These are often state-funded, public treatment providers.

Covered Medi-Cal Services

Under the ACA, Medi-Cal covers substance abuse treatment services along with mental health care and behavioral health treatment. Addiction treatment falls under the 10 core essential health benefits that are automatically covered by this form of state-based health insurance.

Under Medi-Cal, the following substance use disorder (SUD) and mental health services are covered:

  • Outpatient mental health and specialty mental health services
  • Outpatient substance use disorder services
  • Voluntary inpatient detoxification
  • Inpatient specialty mental health services
  • Residential SUD treatment services

Both outpatient and residential drug rehab services can include behavioral therapies, counseling, medication management, life skills training, educational programs, relapse prevention and recovery support, and detox.

Medi-Cal is a version of Medicaid that is either low-cost or free, depending on eligibility.
For specifics about an individual plan, contact the insurance provider directly. A trained professional can guide you through what your plan covers and how to use your coverage to pay for drug rehab and associated services.

Obtaining Medi-Cal Coverage

To obtain Medi-Cal coverage, you can apply at Covered California online, in person, or by phone. Once your application has been received, it will be reviewed by your county’s human services agency.
In the state of California, health insurance and health care coverage can vary by county. A county representative will contact you if more information is needed. Otherwise, you will get a notice within 45 days of submitting the application, indicating whether or not you qualify for coverage under Medi-Cal. Health plans will vary depending on your county of residence. 

Medi-Cal is generally available to the following groups:

  • Adults with income levels that are 138 percent or more below the federal poverty line (FPL) 
  • Pregnant women
  • Adults with dependent children
  • Foster children
  • Former foster children up to the age of 26
  • Individuals suffering from disabilities
  • Seniors aged 65 and older

To be eligible for Medi-Cal, you will need to be a U.S. citizen or a qualified legal immigrant and a resident of California, as well as a resident of the county where coverage is sought.

Coverage is provided on a county-based level, and initial coverage is under Medi-Cal Fee-for-Service.

Within the first month, you will need to choose a managed health care plan based on the county in which you reside. Some counties only have one health plan, and in some cases, the state will choose your plan for you.

Plans can differ slightly depending on where you live and your eligibility. They are also offered through outside providers. Specific provider representatives can give you detailed information on your chosen plan and how to access it for services.

Medi-Cal as Payment for Drug Rehab

Medi-Cal is accepted by state-funded and county-overseen community-based public health providers. Public drug rehab facilities often accept Medi-Cal as a form of payment.

Medi-Cal plans are low-cost or free versions of the same health plans offered under Covered California; therefore, they have the same benefits.

To find a provider that accepts Medicaid or Medi-Cal, SAMHSA’s Behavioral Health Treatment Services Locator can help. It offers current information on local drug rehab and mental health care providers. 

The California public health care system is run through a managed care system that offers services on a local and community-based level. 

To receive drug abuse and addiction treatment services, you will often start with your primary care provider. Specialty services, such as drug rehab, usually need to be classified as “medically necessary” before being covered.

Pregnant women, people in immediate crisis, individuals struggling with mental health concerns, people using drugs by injection, and parents with young children who may be at risk are generally given priority treatment in public drug rehab facilities that accept Medi-Cal for payment.

Your specific Medi-Cal provider will have a referral line for information on how to obtain specialty services like drug rehab. The Medi-Cal Member and Provider Helpline can offer assistance as well.

Medi-Cal Costs

Medi-Cal coverage is often free. It is used like any other health insurance plan to pay for services like drug rehab.
If premiums are required as a beneficiary of Medi-Cal, they are often low, cost-efficient, and based on income and household resources. Drug rehab may need to be preapproved.
Not all drug rehab services and options are covered by Medi-Cal or any insurance. You will need to pay for these out of pocket.

Assistance With Navigating Coverage

An experienced admissions counselor at a drug rehab center can be a wonderful resource for understanding your coverage and how to use it pay for services. Payment plans and budgets can be worked out ahead of time, so all costs are known and planned for up front.

Medi-Cal can cover some of the costs of drug rehab. In fact, drug rehab benefits that are covered by Medi-Cal are often covered completely. There are many options available to manage any remaining costs for services that aren’t included.

Medi-Cal can be a great resource, opening up access to care to those who were previously uninsured or unable to obtain health care due to limited resources.

Sources

Affordable Care Act (ACA). HealthCare.gov. Retrieved March 2019 from https://www.healthcare.gov/glossary/affordable-care-act/

What Marketplace Health Insurance Plans Cover. HealthCare.gov. Retrieved March 2019 from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

(2019). Medi-Cal. Covered California. Retrieved March 2019 from https://www.coveredca.com/medi-cal/

(2019). Medi-Cal Benefits. Covered California. Retrieved March 2019 from https://www.coveredca.com/medi-cal/benefits/

(October 2017). Medi-Cal Provides a Comprehensive Set of Health Benefits That May be Accessed as Medically Necessary. California Department of Health Care Services. Retrieved March 2019 from https://www.dhcs.ca.gov/services/medi-cal/Documents/Benefits_Chart.pdf

(2019). Apply for Coverage. Covered California. Retrieved March 2019 from https://www.coveredca.com/apply/

(December 2017). County Offices to Apply for Health Coverage, Medi-Cal, and Other Benefits. California Department of Health Care Services. Retrieved March 2019 from https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

(January 2019). Medi-Cal Managed Care Health Plan Directory. California Department of Health Care Services. Retrieved March 2019 from https://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx

(September 2018). Medi-Cal Member and Provider Helpline. California Department of Health Care Services. Retrieved March 2019 from https://www.dhcs.ca.gov/individuals/Pages/Medi-CalMemberHelpline.aspx

(January 2019). Medi-Cal Eligibility & Covered California FAQs. California Department of Health Care Services. Retrieved March 2019 from https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014a.aspx#2

Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://findtreatment.samhsa.gov/

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