In some cases, State funding programs like Medicaid and Medicare can help people with substance abuse problems to cover the costs for their treatment programs. These programs may include the actual rehabilitation treatment – inpatient or outpatient, depending on the needs of the individual – or a detox program that may or may not be necessary for the individual to progress to an actual treatment program.
In certain cases, these funding programs can even accommodate treatment programs that are already underway. It’s important to understand what these programs are and how they can affect your substance abuse treatment.
What are Medicaid and Medicare?
Medicaid and Medicare are actually two of the most common methods that people use to pay for their rehabilitation from a drug or alcohol problem. These are both state-funded medical insurance programs, and they’re able to provide low-cost and sometimes free treatment to people with substance abuse problems.
Each program is unique and offers different features. Each program also has different prerequisites that determine whether or not a person is eligible for benefits. These rules can differ from state to state, and the rules tend to change on an annual basis.
This can be good news or bad news – if you have been declined for Medicare in the past, you may be eligible to receive treatment now. Conversely, you may find yourself ineligible if the rules change against your favour.
Medicaid for Substance Abuse Treatment
So what’s Medicaid all about? Medicaid is a publically funded insurance program that intends to help low-income families with social funding that they may otherwise struggle with. Thanks to the Affordable Care Act, also known as Obamacare, insurance providers like Medicaid are required to cover the most basic aspects of recovery from substance abuse problems.
The tricky part here is that Medicaid may cover substance abuse treatment, but unfortunately not all facilities accept it as a viable form of payment. You will have to do your own research to find out which treatment facilities accept Medicaid as a form of payment; we’ll be providing more information about that later in the article.
Substance Abuse and Mental Health Services Administration can help you determine some facilities near you that accept Medicaid as a form of payment.
Eligibility for Medicaid
The most basic eligibility requirements for Medicaid are as following. You need only meet one of the following requirements to be eligible.
- Being a senior (over 65 years old)
- Being a minor (under 19 years old)
- Being pregnant
- Being a parent of one or more children
- Having a median income within a certain bracket
Those are the general requirements, but as we’ve mentioned, Medicaid eligibility can differ from state to state. Some states allow all adults at a certain level to be covered by Medicaid. People who receive Supplemental Security Income are usually eligible to receive benefits regardless.
Obamacare requires that people earn less than 133% of the federal definition of poverty to be eligible to receive benefits, but a person living about this poverty line might still be eligible to receive benefits if they are within a certain income bracket.
- If your family is a single person, you can’t make more than $15,654.10 annually.
- If your family has two people, you cannot have an annual income of more than $21,186.90.
- If your family has three people, your maximum income cannot be more than $27,121.50.
However, these rules are just a general guideline and do not guarantee eligibility. You must check with your local state guidelines and any local facilities to find out for certain whether or not you are eligible to receive Medicaid payment.
What can Medicaid cover?
People who receive Medicaid don’t have co-payments for substance abuse treatment in the majority of states. There are some that charge co-payments, and for these states, there’s an out-of-pocket maximum that Medicaid recipients must pay.
Medicaid should cover all of the following services in most states and at least part of them in all states:
- Screening to determine your treatment needs
- Intervention in the case of emergency treatment being required
- Drug maintenance, like opioid maintenance therapy, and medications to reduce cravings
- Counseling for family members and loved ones
- Inpatient rehabilitation and long-term residential treatment for serious addictions
- Detox programs to help people through the immediate withdrawal phase
- Outpatient rehab and outpatient visits for those with less severe addictions
- Other mental health services that are required to help the treatment progress successfully
These conditions are the primary prerequisites that one needs to meet to obtain Medicaid treatment. You need not meet all the criteria, but at least one of them must be present for you to receive benefits.
Medicare for Substance Abuse Problems
Medicare is typically available for any senior citizens over the age of 65, as well as anyone who is considered to have a disability in the medical system. Medicare is a monthly premium and the premium is calculated based on the recipient’s current income. People who are less financially stable are going to have to pay less of a premium.
Medicare covers the cost of inpatient and outpatient substance abuse treatment. There are four parts that cover different areas of the substance abuse treatment process.
The parts of Medicare
- Part A – Insurance for hospital stays. Part A can also cover the cost of inpatient rehabilitation for up to 60 days without a co-insurance payment being made, however, people using part A of the Medicare program are going to have to pay a deductible. Over the course of a lifetime, Medicare will only cover 190 days of inpatient treatment.
- Part B – Medical insurance. This part is used more to cover outpatient rehab for people who have a less serious addiction. Medicare can cover up to 80% of the costs associated with outpatient rehab. This can include therapy, any drugs that are needed for cravings, maintenance, or for detox treatment and withdrawal management, as well as any intervention that are required to help someone get through their treatment program. Part B will also help you manage any co-occurring disorders that occur alongside your substance abuse problem.
- Part C – Medicare-approved private insurance. If you feel that you need to receive more benefits from Medicare in accordance to your substance abuse treatment program, you can try for part C. The out-of-pocket fees and the comprehensive level of coverage is different for people opting for level C, and they may be more expensive.
- Part D – Prescription insurance. Part D is useful for people who are hoping to cover the cost of their addiction-related medication. A lot of people who are recovering from an illicit drug problem often need medications to help them manage their withdrawals or the cravings associated with drug use. These medications, which can help a person stay clean from drugs and alcohol, are covered by part D of Medicare.
It’s possible for you to be eligible to receive benefits from both Medicaid and Medicare. To find out, you’ll have to check the eligibility requirements and then apply for benefits from each program and apply them to the cost of your treatment. You’ll have to be eligible for Medicare to receive both benefits, which means you’ll have to be a senior citizen or have to be a disabled individual.
Finding a State-funded Rehab Center
According to the National Survey on Drug Use and Health in 2014, there were more than 4 million people who struggled with substance abuse problems that year. Only 2.3 million of these people got their treatment from a facility that was specifically designed to treat addiction problems.
Finding a facility that is funded by the State can help people who didn’t make it into this statistic. Many people are worried about a stigma being associated with publically funded treatment programs, but when push comes to shove, you are gambling with your life here. It’s much more important to receive any form of professional treatment and face a bit of social judgment than it is to risk trying to finish your recovery yourself – especially if you have already tried and failed to seek treatment on your own.
It’s important to know that the treatment facilities that are covered by Medicare and Medicaid still provide evidence-based therapy and other medically-approved therapeutic methods and counseling interventions to help people overcome their addiction problems. The tools and programs used to help people gain back control of their lives are the same as those used in facilities that require patients to pay out of their own pocket.
What are State-Funded Rehab Centers?
A lot of people don’t really know where to start when they’re hoping to find a state-funded rehab center. These facilities are organizations that use money provided by the government and distributed by the state to help people overcome and manage their substance abuse problems.
These programs are absolutely crucial for people who don’t have a high-income bracket and struggle with addiction problems. It can be very difficult for low-income people to seek treatment when they’re trying to manage a drug addiction, a job, and a family all at once. This is one reason why so many people never manage to seek treatment.
The money that goes to fund these programs comes from a wide variety of different sources. It’s difficult for people to figure out exactly how much money they’re entitled to because the benefits vary from state to state, just like the requirements for receiving treatment.
It’s important that you check with your local state funding bursaries because a lot of the time, state-funded addiction treatment programs are included as a part of other state services and social services. These could be a part of child services, criminal justice programs, or any other areas that your state deals with welfare programs. Your connection and eligibility to these programs may affect your eligibility to receive treatment for your substance abuse problem.
How soon can I expect treatment?
Since you’re going to be paying for your treatment program with money that is granted by the State, that means that you’re dealing with a limited amount of finances that are going to be distributed among a lot of people. That means that there is going to potentially be quite the waiting list for you to get into the facilities that are covered by these insurance programs.
Furthermore, you may or may not be able to receive priority for treatment. For example, pregnant women are more liable to receive treatment before someone who is in good health and merely struggling with their median income; this would subsequently mean that people who aren’t pregnant are going to be bumped down the waiting list.
Don’t let this deter you from seeking help, though. It’s better to be on a waiting list than it is to simply eschew seeking treatment whatsoever. The National Institute on Drug Abuse has noted that people are much more likely to actually seek substance abuse treatment if it’s easily available at the moment that they actually desire to make a change, so a lot of these institutions provide outpatient rehab or maintenance therapy for people in the meantime while they’re on the waiting list for more intensive inpatient treatment.
How does this treatment compare to non-state funded treatment?
Since you’ll be dealing with a treatment program that is funded by limited finances, you won’t have access to the best technologies that state-of-the-art rehabilitation programs can offer.
However, this by no means suggests that the treatment you’ll receive won’t be effective. Treatment at any level is usually better at providing a positive outcome, or at least pushing someone in the right direction, than having no treatment whatsoever. State-funded programs have shown great success in providing patients with the following, and much more:
- Lowering the instance and frequency of substance abuse; increasing the length and frequency of abstinent periods
- Improving personal health, both mentally and physically
- Improving social and familial relationships damaged by substance abuse problems
- Increasing public and community health and relationships
- Improving the safety of the addicted individuals as well as those associated with them
All of these factors are improved notably more than in cases where people sought no treatment whatsoever or declined treatment out of fear that it would not be adequate when compared to private treatment.
Publicly funded substance abuse programs have been shown to lower crime rates while being much more cost-effective than private options. This makes state-funded treatment programs just as valuable as private programs – they may not provide the same level of comprehensive treatment, but considering they provide it at no cost or at a fraction of the price, you can recognize that they are substantially higher in value than trying to treat the problem yourself or with your own social supports.
What can I expect from a State-funded program?
Not many state-funded programs use newer, alternative treatment methods. A lot of treatment programs these days are exploring alternative, holistic treatment methods to broaden the efficacy of treatment programs and to offer a wider variety of options to help people who may not be responsive to the traditional treatment methods, like the 12-step program.
While these programs tend to rely on these traditional, evidence-based programs, that’s not necessarily a bad thing. These programs have been used for dozens of years and have been proven to be reliable and effective, at least as an introduction in the path to rehabilitation.
State-funded programs may not have the same level of in-house counseling and support as privately funded programs. They may only offer a detox program and medical management therapy. However, these programs often refer the client to counseling services and self-help groups which may, in turn, be covered by Medicaid or Medicare. This is in contrast to privately funded rehabilitation programs, most of which offer counseling and therapy at the facility itself.
These facilities are also not likely to be as comfortable as privately-run rehabilitation facilities. A lot of privately funded facilities are developed to provide as ‘homely’ of an atmosphere as possible, to make their patients feel comfortable and to enable them to approach treatment in a manner that doesn’t make them feel like they’re doing something so far out of their comfort zone.
These programs are intended as a basic utility with one goal – stop the patient from abusing drugs and return them to a functional life as a member of society. They are not intended to create a spa-like environment to help the patient feel extremely comfortable and pampered. For those who truly want to overcome their addiction, this environment should be enough for them to take steps in the proper direction.
Finding a state-funded rehab
If you’re ready for treatment then there are a few things that you can do to help yourself find a state-funded rehab facility. The UnitedRehabs.com is a great place to begin. This directory has information for each state’s drug and alcohol abuse policy and will provide funding and service information. This is a great way to find out information about your specific state.
UnitedRehabs.com, as we have mentioned already, is a great way to find a list of treatment facilities that accept funding from Medicaid and Medicare. They have an interactive page that allows you to engage in a visual search of state centers and local facilities based on your municipality. You can also search with filters that allow you to narrow the search query based on your location, address, and certain preferences that might make it easier for you to find a suitable facility.