Medi-Cal (California Medicaid) Drug And Alcohol Rehab Coverage

Medi-Cal, California’s Medicaid program, offers health care services for the treatment of substance use disorders. This assistance may help you to obtain outpatient, residential, and opioid treatment program services, among others.

Drug And Alcohol Rehabs That Accept Medi-Cal Health Insurance

In 2015, California became the first state in the nation to receive federal permission to restructure substance abuse treatment for Medicaid beneficiaries, a move which has made these life-changing services more widely accessible to the over 13 million Californians who receive Medi-Cal, California’s Medicaid program.

From these changes, individuals in need should be able to better access services for detoxification and the treatment of alcohol and drug addictions, including those caused by opioids.

What Is Medi-Cal?

Within California, Medicaid is referred to as Medi-Cal, a program which is funded in equal parts by the State and federal governments. According to the California Department of Health Care Services (DHCS) Medi-Cal:

is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS.

Those eligible for Medi-Cal also include individuals without children aged 19-64.

Many of Medi-Cal’s services are made accessible through waiver programs, including those rendered for the treatment of substance use disorders.

Does Medi-Cal Provide Services For Substance Abuse Treatment?

Yes. And as of 2015, these services have been expanded to include even more individuals. In this year, the federal government approved California’s Drug Medi-Cal Organized Delivery System
(DMC-ODS) Waiver amendment. This approval enacted changes which required that evidence-based practices for the treatment of SUDs be used more readily.

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One of the main goals of this waiver is to provide Medi-Cal beneficiaries with a “continuum of care for substance use disorder treatment services” which are based upon those established by the American Society of Addiction Medicine (ASAM) Criteria for SUD treatment services. Should a county decide to participate in the DMC-ODS they must provide services which are based upon this criteria. As of May 2017, the DMC-ODS covered 74 percent of California’s population, as outlined by the DHCS.

In order to be part of this initiative, the following services must be provided to those Medi-Cal recipients in need, as sourced directly from a DHCS document:

  • Early Intervention (overseen through the managed care system)
  • Outpatient Services
  • Intensive Outpatient Services
  • Short-Term Residential Services (up to 90 days with no facility bed limit)
  • Withdrawal Management
  • Opioid/Narcotic Treatment Program Services
  • Recovery Services
  • Case Management
  • Physician Consultation

Additional benefits of these enhanced services include treatment which is coordinated around an individual’s physical and mental health care needs.

This is critical when treating addiction, as substance abuse can deeply affect a person’s physical and mental health, often to the point where integrated care is necessary for a full and lasting recovery.

In order to obtain these services, certain documentation may be required so that Medi-Cal can confirm that substance abuse treatment is medically necessary. This means that the substance use disorder must be documented and also that evidence is provided which illustrates that substance abuse treatment is necessary in order for a person to get well.

To determine this a substance abuse assessment will likely be conducted. This evaluation will not only confirm this need, it’ll also establish what treatment(s) are appropriate and necessary.

Certain factors which may be examined include identifying:

  • the drug of abuse
  • how long the substance has been used for
  • how often the substance is used for
  • the impact the abuse has had on a person’s life (e.g. detriment to a person’s health, family, and/or job)
  • health and medical history, including presence of any co-occurring mental health disorders
  • treatment history, if any

Once a person’s addiction, health, and life are assessed, an appropriate treatment plan should be identified. If you would like any guidance on this process, we can help. Our highly-trained specialists can help you to determine what assistance your health care coverage offers and what treatment plan is best for your specific needs.

Does Medi-Cal Cover The Cost of Outpatient Substance Abuse Treatment?

In counties which participate in the DMC-ODS an individual may have the option of either outpatient services or intensive outpatient services (also referred to as intensive outpatient programs or IOPs). Before choosing either of these services it’s important to fully understand the role outpatient care has within addiction treatment.

First, intensive outpatient services are more intensive than those provided within outpatient services, namely due to the increased time spent within treatment. Typically, both programs offer therapy and counseling in individual and group formats. However, though not as rigorous or intensive as inpatient programs, IOPs do involve an individual more frequently in counseling and therapy sessions.

Intensive outpatient programs are best for those whose substance abuse isn’t severe enough to warrant the residential format of an inpatient program. Depending on a person’s individual progress and health and medical needs, either of these programs may help a person transition, or “step down,” from an inpatient treatment program into independent living.

Keep in mind, outpatient programs quite often allow a person to confront harmful triggers within their life, whether they be people, places, or events, which could tempt them to relapse. For this reason and due to the more intensive format of treatment, many individuals find they can heal and recover more fully within inpatient treatment.

Does Medi-Cal Cover The Cost Of Treatment At An Inpatient Rehab Center?

If a person resides in a county which offers the DMC-ODS waiver they may be eligible for treatment at an inpatient drug rehabilitation which offers evidenced-based addiction treatment.

Following the ASAM guidelines, the DMC-ODS criteria requires that short-term residential services, or those up to 90 days, be available. This is good news, as the National Institute on Drug Abuse recommends three months, at minimum, for the highest chance of sobriety and a successful recovery.

An addiction can cause a state of upheaval in an individual’s life, and the stability and security inpatient treatment offers supports the healing and personal growth which are foundational to a solid recovery.

Individuals confronting moderate to severe addictions are typically those who require this treatment, though an individual’s specific needs should always be evaluated in order to make this determination. Opioid addictions caused by heroin and prescription painkillers are often those which necessitate this care.

Medi-Cal does offer opioid or narcotic treatment program services; for some individuals this care may be offered through a residential inpatient drug rehabilitation program. For these individuals, medication-assisted treatment (MAT), a combination of therapy and medications, are often used.

Does Medi-Cal (California Medicaid) Cover the Cost of Suboxone?

According to the DHCS, California has implemented strategies which make buprenorphine more accessible and widely used across the state.

Suboxone is a combination medication of buprenorphine and naloxone which is frequently used within medication-assisted treatment to treat opioid use disorders. Suboxone diminishes cravings and symptoms of withdrawal, making it a beneficial medication for medically-supervised detoxification.

As detailed by the California Society of Addiction Medicine, a Treatment Authorization Request (TAR), or prior authorization, is no longer required by Medi-Cal for most buprenorphine medications. They do note that a DEA waiver and a diagnosis of opioid addiction are necessary to obtain the medication.

The combination of these changes should make it easier for an individual to access Suboxone in a timely manner so that they can begin recovering from their opioid addiction.

Does Medi-Cal Cover the Cost of Methadone Maintenance?

It may be determined that certain individuals with Medi-Cal are best treated within a methadone maintenance program. A DHCS document outlining medication-assisted treatment for heroin use writes that:

Detoxification by the use of methadone may be carried out only in an inpatient or
outpatient facility approved by DHCS….The only exception to this required
approval is the use of methadone for heroin detoxification in emergency situations
where detoxification is part of the overall treatment of a severely ill or injured

Treatment specifications for other opioids may follow a similar format.

Methadone is an opioid agonist used as a maintenance medication for the treatment of opioid use disorders, including those stemming from heroin and/or prescription opioid painkillers. Methadone reduces cravings and the symptoms of withdrawal, helping a person to reduce or quit their opioid abuse, so that they can live a more functional, healthy life.

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Finding A Rehab Center That Accepts California Medicaid

If you or a loved one is facing an addiction to drugs or alcohol and has Medi-Cal, your health coverage may include treatment for these substance use disorders. Before you commit to a treatment program it’s in your best interest to have your needs assessed, a process we can help you with.

Your treatment plan should be centered on your unique needs. For instance, if you are struggling with a co-occurring mental health disorder like anxiety or depression, it’s important to take a look at the Medi-Cal coverage for these concerns.

If you’re addicted to alcohol, benzodiazepines, or opioids, you may require a medically-supervised detoxification supported by certain medications. After this, a transition into inpatient treatment may be the best treatment plan, with certain facilities offering these treatments under one roof.

Our treatment specialists can help you to examine these options and more. We can also contact Medi-Cal on your behalf to help you determine how your coverage works, including what it covers.

Contact a treatment specialist today ator more information on how your Medi-Cal coverage could help you to obtain your recovery goals.

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