MassHealth Drug And Alcohol Rehab Coverage

If you live in Massachusetts and are struggling with an addiction to drugs and/or alcohol, your MassHealth plan may cover your stay in an inpatient rehab center.

Drug And Alcohol Rehabs That Accept MassHealth Health Insurance

Residents of Massachusetts who have MassHealth may find their coverage helps them obtain affordable treatment for a drug or alcohol addiction, including care which targets co-occurring mental health disorders.

Massachusetts has been hard hit by our nation’s opioid epidemic. For individuals facing an addiction to heroin, prescription opioid painkillers, or any other drug of abuse, drug or alcohol addiction treatment may be a more attainable goal with the help of your MassHealth plan.

MassHealth Provides Residents Of Massachusetts With Affordable Healthcare Options

MassHealth is a state-run public health care program offered to residents of Massachusetts. MassHealth’s benefits are extended to low and medium income individuals, with a special focus on certain at-risk or uninsured populations.

Specifically, “MassHealth offers different types of coverage based on your age, whether you are a parent, pregnant, disabled HIV positive or have breast or cervical cancer, and whether you work for a small employer,” as explained by

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MassHealth is comprised of Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid is a Federal-State health insurance program which provides coverage for low-income adults, children, disabled individuals, elderly adults, and pregnant women. The Children’s Health Insurance Program covers individuals under age 19.

Understanding Your MassHealth Addiction Treatment Coverage Options

If you have MassHealth health insurance your coverage may provide assistance for detoxification, outpatient treatment, and inpatient drug rehabilitation programs. Your exact coverage will be determined by your plan, and your specific treatment needs by your life and the circumstances surrounding your addiction.

Before you commit to these or other substance abuse treatment services it’s important to understand the basics of your plan. To start with, according to, MassHealth is offered through six coverage types, including:

  • Standard
  • CommonHealth
  • CarePlus
  • Family Assistance
  • Premium Assistance
  • Limited

MassHealth plans are offered through various organizations which provide these insurance options. In addition to coverage types, there there are also three types of plans:

  • Accountable Care Organizations (ACOs)
  • Managed Care Organizations (MCOs)
  • Primary Care Clinician (PCC) Plan

The specifics of these plans and the extent of their coverage vary. The network, or group of doctors, hospitals and other health care providers which you are able to access care from, also varies per plan. In turn, the exact way your treatment covers substance abuse may differ from plan to plan. explains that “MassHealth offers health-care benefits directly or by paying part or all of your health-insurance premiums.” In many cases, these offerings may make substance abuse treatment easier to obtain. Even if your costs are low, it’s still helpful to understand your deductible and treatment co-pays, so that you can better anticipate and plan for any out-of-pocket costs associated with treatment.

Familiarizing yourself with these details can enhance the planning process so that you’re better able to access care which falls within an affordable price range and is customized to your needs.

How To Use Your MassHealth Plan For Drug Or Alcohol Addiction Treatment

As outlined by a publication, MassHealth provides services which treat substance use disorders, including, but not limited to:

  • Acute inpatient substance use disorders treatment services
  • Outpatient counseling services
  • Acupuncture detoxification (within outpatient services)
  • Case consultation
  • Certain services provided by opioid treatment service centers (I.E Medication-Assisted Treatment such as Suboxone or Methadone)
  • Individual, group, and family/couple counseling
  • Special substance use disorder treatment services for pregnant members

Exact coverage details may change and are dependent on each individual’s specific MassHealth plan. In certain cases, out-of-state substance use disorder treatment programs may participate in MassHealth, but certain restrictions do apply.

Pregnant women who wish to utilize their MassHealth coverage may also receive case management, which includes “coordination with community agencies to enhance access to support services for the member during and after treatment,” as detailed by a MassHealth Substance Use Disorder Treatment Manual. An example of these services include family planning, parenting support, and trauma services.

Individuals enrolling in treatment to overcome an opioid addiction may find that their coverage includes certain medications; these medications and the manner in which they are used are regulated by restrictions outlined by MassHealth.

Unless the prescribing doctor specifies otherwise, in these and other circumstances which require medications, the generic form of a medication will likely be filled for a prescription, as stipulated by Massachusetts state procedures.

Generally, if a brand name drug is desired by the doctor they must file a request for a prior authorization (PA); in these cases an approval must be granted by your insurance before the name brand can then be filled. Medications will likely have a copay attached which is the responsibility of the individual in treatment.

Choosing Between An Inpatient Or Outpatient Treatment Program

Inpatient drug rehabilitation programs provide comprehensive coverage for drug and alcohol addictions. The residential format of these programs allows treatment participants to spend more time learning important recovery principles, including the coping methods and relapse prevention skills which build and protect a sober life. Inpatient programs better help to protect an individual from outside influences which could act as relapse triggers.

If finances are a main concern when planning for treatment, as they are with the vast majority of individuals in need of this care, it’s important to make sure you’re utilizing your insurance to the full extent of its coverage. But beyond this, you want to make sure you’re getting the most comprehensive care for your needs; in many cases choosing a cheaper program isn’t always the best choice for your health and life.

When contemplating finances, many people may be tempted to choose an outpatient program due to the fact that they are often cheaper than inpatient programs, or they might choose an inpatient program which is cheaper but does not offer as extensive levels of care. In either of these cases, while a person is saving money in the short term, they could actually be paying a higher cost in the long term.

Without the proper treatment, an addiction can continue and worsen, or a person may be more apt to relapse. Continued substance abuse costs money, not just in terms of the actual cost of the drug, but in regards to health care costs, lost work due to adverse health effects caused by substance abuse, and much more.

Further, the time, health, and quality of life lost from a life of substance abuse is a price no one should have to pay. Choosing an individualized treatment program which offers researched-based treatment methods can make a difference between a life like this and one which has a greater measure of stability, health, and wellness supported by sobriety.

Though outpatient programs do play an important role within addiction treatment, inpatient drug rehabilitation programs quite often provide more individualized, comprehensive care.

Many inpatient drug rehabilitation centers provide medically-supervised detoxification programs on site, allowing individuals to progress from one stage of treatment to the next without ever having to leave the facility. This seamless transition increases treatment retention rates, participation, and success, all things you should consider while planning for treatment.

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Additional Payment Options For Treatment

Since MassHealth provides coverage to individuals with low to medium incomes, treatment expenses are quite often very daunting. Sometimes it can be hard to make ends meet, and adding the cost of treatment to other daily expenses can seem next to impossible.

Fortunately, your insurance and paying out of pocket aren’t always your only options. Sometimes close friends or family members are willing to help, and if this isn’t the case, some treatment facilities have sliding fees which offer reduced treatment costs to individuals in need. In addition to this you might be eligible for a scholarship or grant which could help to offset treatment costs.

Whatever your life circumstances, if you’re facing an addiction to drugs or alcohol, treatment provides you with a life-changing opportunity for sobriety and better physical and mental health.

Contact us today to begin building a treatment plan and to learn more about how your insurance coverage could help you to obtain a drug-free life.

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