As the largest payer of mental health services in America, Medicaid helps individuals to pay for addiction treatment services.
The Mental Health Parity and Addiction Equality Act (MHPAEA) demands that mental health and addiction treatment services be provided at the same level of coverage that other medical and surgical conditions are. This means that individuals covered under Medicaid can receive treatment for drug addiction in the same manner as for any other disease or medical affliction.
Medicaid is a government program that provides healthcare coverage for individuals with limited resources who may not be able to afford private health insurance. The Affordable Care Act (ACA) of 2010 expanded Medicaid coverage to millions of adults. According to the Centers for Medicare & Medicaid Services, an estimated 12% of Medicaid recipients suffer from addiction.
Individuals at or below 138% of the federal poverty level (FPL) may be eligible for Medicaid in Nevada. For pregnant women, the limit is expanded. They can qualify at or below 160% of the FPL. Nevada residents may apply through Access Nevada.
Resources for Finding Drug Rehab That Is Covered by Medicaid in Nevada
Within the state of Nevada, public addiction treatment services are managed under the Nevada Division of Public and Behavioral Health (DPBH) and funded by the Substance Abuse Prevention and Treatment Agency (SAPTA) and by federal grants. In order to be covered by Medicaid for drug rehab in Nevada, the facility must adhere to a medical-model service delivery system, which may be delivered on an inpatient or outpatient basis. SAPTA certifies both public and private addiction treatment centers in Nevada and provides resources for individuals seeking coverage – both those using Medicaid and those using private pay or other health insurance.
Resources for finding drug rehabs in Nevada that accept Medicaid include:
- SAPTA Certified Treatment Provider list with indications on which ones are funded and accept Medicaid
- Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator to find local facilities and peruse what they offer
- Nevada Prevention Resource Center’s (NPRC) list of community coalitions funded by the Nevada SAPTA that provide community-based services in regions around the state
- Nevada Statewide Coalition Partnership’s resources for drug addiction and recovery services.
What to Do When Your Desired Treatment Center Doesn’t Take Medicaid
Many treatment centers take only private insurance or other private payment methods. If you have only Medicaid, you may still have some options. Some people who prefer to go to certain programs that don’t take Medicaid/Medicare explore certain payment options outside insurance. This may include:
- Financing with the facility. Some programs will offer financing to make it possible for you to get into treatment without having to pay all the costs upfront.
- Healthcare loans. Certain companies specialize in healthcare loans that allow you to avoid going into debt with high-interest credit cards.
- Healthcare credit cards. Some credit cards are specifically designed to help you pay for healthcare services, but beware of costly fees that may apply if you don’t pay your balance quickly.
- Asking loved ones for financial support. Options like GoFundMe make it easy for you to ask people to help fund your lifesaving care.
- Scholarships. Some treatment centers offer scholarships to help those who are suffering get the treatment they need for free or at a discounted rate.
- Sliding scales. Certain centers offer adjusted rates based on the patient’s income.
At Desert Hope Treatment Center, we do not accept Medicaid; however, we will work with you to determine if private pay might work for you. Call us at 702-848-6223 to discuss your options.
Using Medicaid to Pay for Treatment
Over 70,000 people in Nevada suffered from illicit drug abuse or dependence between 2009 and 2013, according to the Nevada Behavioral Health Barometer. Only about 9,000 people per year received the care they required between 2005 and 2013.
With the expansion of Medicaid and more people having access to healthcare, there may be more opportunities for individuals to receive affordable treatment. In Nevada, individuals who have coverage under Medicaid can be reimbursed for addiction treatment services. In order to qualify for reimbursement, covered individuals must first receive a referral from a licensed practitioner or physician, and the treatment must be deemed medically necessary. Treatment is to be person-centered, strength-based, supportive of the community, and include the family.
It is also generally desired for treatment services to be provided in the least restrictive environment possible for recovery. This means that a person may need to first attempt an outpatient program and be unsuccessful before an inpatient program will be covered and deemed medically necessary. There may also be a limit on the amount of covered sessions, medications, or number of days spent in a treatment facility in a calendar year. There may also be a financial maximum amount; once breached, individuals will be responsible for paying for the remainder.
Treatment must also be provided at a location that accepts Medicaid coverage for payment to be provided. An individual may need to pay the costs up front and then receive reimbursement from Medicaid.
Covered services may include:
- Outpatient treatment, including group and individual counseling and therapy sessions, medication management, behavioral and occupational therapies, and educational programs.
- Family therapy.
- Preventative services.
- Educational programs.
- Intensive outpatient treatment (IOP), which typically includes more weekly hours than traditional outpatient treatment and may also provide treatment for co-occurring mental health disorders simultaneously as well
- Partial hospitalization, or day programs, where an individual spends the day in treatment and usually returns home in the evenings and on the weekends.
- Residential, or inpatient treatment, which is highly structured providing care 24 hours a day, seven days a week, in a specialized facility focusing on all aspects of recovery.
- Case management.
- Medication management and assisted treatment.
- Continuing care.
- Recovery services, peer support, mentoring, and access to community-based programs.
Drug rehab that is covered by Medicaid in Nevada may be provided in a medical professional’s office or clinic, in a person’s home, within a community environment, in an inpatient substance abuse hospital, in an actual hospital with a substance abuse unit, in a mental health clinic, or by a licensed psychologist or psychiatrist. Medicaid providers usually contract with specific facilities and/or providers. In order to receive coverage or reimbursement, individuals will need to attend rehab in these locations and adhere to their specifications and requirements.
In order to better understand health insurance coverage and what may be covered at what amount, it can be helpful to call the provider directly.