Medicaid Coverage For Addiction Treatment Services Varies Widely Among States

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Medicaid Coverage For Addiction Treatment Services Varies Widely Among States

Thirty-two states have now expanded eligibility for the Medicaid program under the the Affordable Care Act. Since its establishment, an estimated 1.6 million U.S. residents have obtained access to substance abuse services.

However, a study published last week in the journal Health Affairs revealed marked disparities between the states regarding Medicaid coverage.

For the study, researchers set out to determine the number of addiction treatment services available in each state as of 2014. They examined coverage for the four classes of services as identified by the American Society for Addiction Medicine.

These services includes outpatient treatment, intensive outpatient treatment, short/long-term residential inpatient treatment, and intensive inpatient treatment for detoxification.

The study found that twenty-one states had expanded Medicaid, and by default, coverage for substance abuse treatment, as required by federal health law. However, the law also allows states to determine the type of treatment and corresponding medication covered.

In general, researchers discovered that the level of Medicaid coverage for addiction treatment services did not correspond with the Medicaid expansion. Only 13 states and the District of Columbia covered all of the services in the four classes, and another 26 states covered at least one service in each treatment level.

Nine states did not offer reimbursement for substance abuse treatment in at least two treatment levels. States tended to shy away from insuring residential interventions in particular.

In addition to general treatment, divergences from state to state extended to medication used to manage addiction and cravings. All states and D.C. insured buprenorphine, and all but two insured Vivitrol. Yet only 32 programs insured methadone, which according to the American Society for Addiction Medicine, is one of the most effective drugs for managing opioid addiction.

If the use of a drug that is prone to abuse and addiction for such treatment concerns you, consider that in many state Medicaid programs, no such limitations exist for the coverage of addictive painkillers for other issues.

In total, seventeen state Medicaid programs and D.C. covered both comprehensive treatment and all medication indicated for addiction management.

Only 17 state programs and the D.C. insured both comprehensive treatment services and all addiction medications. Also, the study found that in many states, there were barriers to accessing services, such as pre-authorization requirements, annual maximums, and co-pays. Indeed, almost every stated required a pre-auth for buprenorphine, and over one-third imposed co-pays as well.

Around half required pre-authorization for intensive inpatient care, and nine applied annual maximums to recovery services.


The good news is, the expansion has allowed thousands to obtain access to treatment who may not have received it otherwise. However, there are clearly gaps in coverage on a state-by-state basis, and with the imminent threat of Affordable Care Act repeal, Medicaid recipients battling addiction will likely continue to find it difficult to access comprehensive services for the amount of time needed to fully recover.

~ G. Nathalee Serrels, M.A., Psychology

Just Believe Recovery is a fully licensed, Joint Commission accredited, comprehensive drug and alcohol treatment center located in Carbondale, Pennsylvania

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