The Opioid Epidemic in Tennessee
In 2016, out of every 1,000 TennCare members, 19.6 had a diagnosed opioid use disorder. This number was 10 people more and 104 percent higher than it was only four years earlier.
Addiction treatment is one of the best defenses against the dangers of opioid abuse. TennCare is committed to addressing the opioid epidemic. Their benefits include outpatient and inpatient substance abuse services for opioids and other forms of drug abuse.
What Is TennCare?
In Tennessee, Medicaid is referred to as TennCare. TennCare was established in 1994, making it one of the oldest Medicaid managed care programs in the nation today.
Roughly one out of five Tennesseans are covered by TennCare. TennCare members are mostly:
- low-income pregnant women
- individuals who are elderly
- individuals who have a disability
TennCare benefits are provided through various Managed Care Organizations, all of which are considered one of the top 100 Medicaid health plans in the United States.
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Examples of the Managed Care Organizations which partner with TennCare include:
- TennCare Select
- UnitedHealthcare Community Plan
TennCare also offers a Pharmacy Benefits Manager for coverage of prescription medications.
Does TennCare Cover Services For Substance Abuse Treatment?
Yes. TennCare has several benefits packages, all of which offer inpatient and outpatient substance abuse benefits. In certain cases, while these benefits may be covered, Medicare is the primary. This means that the majority of the responsibility for substance abuse treatment would fall to Medicare.
In order to find providers which accept TennCare or to determine a person’s specific benefits, their specific Managed Care Organization should be contacted. Treatment specialists can contact these groups on a patient’s behalf to find out what addiction services are covered. At this time, any copay, coinsurance, and deductible can be determined so that a person can anticipate their out-of-pocket expenses.
Getting Coverage And Building An Addiction Treatment Plan
TennCare may require certain documentation to confirm that substance abuse treatment is medically necessary before they provide addiction treatment services. What this means is that a person must submit evidence documenting the addiction and reasons why treatment is necessary for recovery. This information may include doctor’s notes or letters and a clinical assessment.
A clinical assessment is an evaluation that screens for a drug or alcohol addiction. It also looks for any other problems or health conditions which could influence the addiction or line of treatment.
This assessment should be administered by a professional who is trained in addiction medicine. They will ask a variety of questions, which may include:
- Has the person been to treatment before?
- What is the drug of abuse?
- How long has the drug been abused for?
- How often does the person take the drug? In what amounts?
- Has the drug abuse caused any damage to the person’s health, family, and/or job?
- Does the person have a co-occurring disorder? (A mental illness which occurs with addiction.)
The assessment will likely include a physical exam accompanied by questions about a person’s health and medical history.
This information will help to build a treatment plan. It will also show what treatments and therapies should be used to give a person the best chance for recovery. For instance, if a person has a co-occurring disorder like anxiety or depression they should receive dual diagnosis treatment.
Does TennCare Cover The Cost of Outpatient Substance Abuse Treatment?
Outpatient substance abuse benefits are included in TennCare’s benefit packages. But before a person uses these benefits, it’s important that they discuss the role of outpatient care in their treatment plan with a trained professional.
Certain people may be able to seek outpatient treatment only, however, when a person has a moderate to severe addiction inpatient care if often preferred.
Outpatient programs offer access to the outside world during treatment. While it may seem appealing that a person can return home after therapy sessions, this flexibility may expose them to temptation and triggers for relapse.
Many people find that outpatient programs work better when used as a step-down service. This means that they follow a residential inpatient program and work as a bridge between treatment and sober living. A TennCare member support representative can help to determine if outpatient treatment is covered in this way.
Does TennCare Cover The Cost Of Treatment At An Inpatient Rehab Center?
TennCare does provide its members with inpatient substance abuse benefits. The exact amount covered and length of services provided will be determined by a person’s specific benefits.
The best addiction treatments provide services which treat the mental, emotional and physical impacts of addiction. The longer a person has to work on these issues, the better. Inpatient drug rehab programs generally give a person more time in therapy. The length of treatment is often longer, too. Inpatient treatment may last 30, 60, 90, or 120 days. Some programs are a year or longer. Because of these considerations, many treatment providers recommend a residential inpatient program.
Inpatient programs offer various therapies which focus on healing and rebuilding positive life skills. Behavioral therapies in an individual, group, or family setting play an important part in this process.
Certain people may need to detox before they begin this portion of treatment. This is common with individuals who are addicted to alcohol, benzodiazepines, or opioids. Medications may be used during this time to help a person safely withdrawal from their drug of abuse.
Does TennCare Cover the Cost of Suboxone?
TennCare’s Opioid Strategy includes a buprenorphine medication-assisted treatment (MAT) program. This includes detoxification supported by MAT.
Suboxone, a combination of buprenorphine and naloxone, is frequently used as part of medication-assisted treatment for opioid use disorders. Suboxone reduces cravings and other uncomfortable symptoms of withdrawal. For this reason, it’s frequently used during a medically supported detox.
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The exact dosages which are covered will have to be confirmed with TennCare and the treatment provider. In order to obtain a prescription for buprenorphine, a prior authorization will likely have to be obtained. This means that the prescribing doctor must get permission from TennCare before they’re able to prescribe buprenorphine.
Does TennCare Cover the Cost of Methadone Maintenance?
In 2005 TennCare stopped covering methadone except for individuals under age 21.
Methadone is most typically use as a maintenance medication for the treatment of opioid use disorders, however it’s also used during the detoxification process.
If a person is interested in either of these options a treatment specialist can find a program that uses this medication. Since TennCare benefits can’t be used, they can also suggest additional ways to pay for treatment, including the possibility of scholarships and grants.
Finding A Rehab Center That Accepts TennCare
It can take time to find the right program for a person’s needs, and understanding TennCare insurance benefits can make this process move quicker.
Using TennCare benefits to obtain addiction treatment can give a person an opportunity they may not otherwise have. This care could potentially be life-changing.
If TennCare doesn’t cover the full amount of treatment, other options may exist. Some individuals use scholarships or grants to get treatment, while others reach their goals through the help of family and friends. Individuals who are struggling financially may qualify for a sliding-fee scale. Certain treatment centers offer this option to reduce a person’s out-of-pocket expense based on their income.
Contact OpioidTreatment.net today to find out how TennCare can help you achieve your recovery goals.