An OPEN MINDS Market Intelligence Report
How state Medicaid programs cover addiction treatment service—and what services they cover—varies from state to state. Addiction services can be categorized into three groups: detoxification (including inpatient detoxification, non-hospital-based detoxification); treatment (including outpatient treatment and residential treatment); and medications (including pharmacy and medication-assisted treatment). Among all state Medicaid programs, only two states offer no coverage for addiction treatment services and only six states offer the full continuum of addiction treatment services – inpatient detoxification, non-hospital-based detoxification, outpatient treatment, intensive outpatient, residential treatment, and medication-assisted treatment. (For more on state coverage of addiction services, see What Addiction Treatment Services Are Covered By State Medicaid Programs?: An OPEN MINDS Market Intelligence Report).
State-managed addiction treatment services varies widely as well, but most states use one of three main models to deliver addiction treatment services: Fee-for-service; Managed care, with no carve-out; or Managed care, with carve-out to a managed behavioral health organization.
A carve-out is a Medicaid managed care financing model where some portion of Medicaid benefits—dental services, pharmacy services, mental health services, addiction treatment services, etc.—are separately managed and/or financed. For addiction treatment benefits, the benefits are often broken down even further into specific service categories, including emergency services for addiction disorders, inpatient detoxification, detoxification in a non-hospital based setting, outpatient services, residential treatment, and methadone maintenance. These benefits can be managed in the same financing and delivery system or each service can be provided through a different financing and delivery system arrangement.
The OPEN MINDS Market Intelligence Team conducted an analysis of the 50 state and District of Columbia Medicaid programs. The analysis determines the delivery system for inpatient detoxification, detoxification in a non-hospital based setting, outpatient services, residential treatment, and methadone maintenance. The report answers a number of questions, including:
- What Is A Medicaid Carve-Out?
- Which States Carve Addiction Treatment Benefits Out Of Medicaid Managed Care Contracts?
- What Is The Future Of Addiction Treatment Carve-Outs?
