An OPEN MINDS Market Intelligence Report

State Medicaid programs cover addiction treatment and are the largest health insurance payer for these benefits, spending more than $5.2 billion a year. Despite being the largest payer of addiction treatment benefits, state Medicaid coverage of these benefits is optional and varies widely from state to state. Some states cover the full continuum of substance abuse benefits – detoxification, outpatient services, intensive outpatient, residential treatment, and medication assisted treatment – while others offer some, or none of these benefits.

Under the Patient Protection and Affordable Care Act of 2010 (PPACA), states that expand Medicaid to childless adults between the ages of 18-64 with income below 138% of the federal poverty level must offer Medicaid services to this population through an Alternative Benefit Plan (ABP). The PPACA regulated that ABPs must provide the ten essential benefits, which includes addiction services. Therefore, even if a state expands Medicaid, but does not have an addiction benefit for the non-expansion population, addiction services must be covered for the expansion population.

An OPEN MINDS survey of state addiction treatment benefits found that 48 states provide at least outpatient benefits and two states offer no addiction treatment benefit to the general Medicaid population. Only six states provide the full continuum of addiction treatment benefits. This report provides a state by state listing of the substance abuse services in each state, covered medication-assisted treatment drugs in each state, and a complete explanation of the Medicaid rules about addiction treatment. The report answers a number of questions including:

  1. What Are The Addiction Treatment Coverage Requirements For State Medicaid Plans?
  2. What Is The Continuum Of Addiction Services Covered By State Medicaid Programs & How Are They Defined?
  3. What Addiction Services Are Covered By State Medicaid Programs?
  4. What Are The New Options For Providing Residential Treatment Services?
  5. What MAT Benefits Are Covered By State Medicaid Programs?

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