Getting Medicaid Rehab in New Jersey

Under the Affordable Care Act (ACA), Medicaid must cover essential health benefits, including addiction treatment and mental health services. Medicaid covers both drug and alcohol addiction treatment, and alcohol rehab is covered under most Medicaid plans. However, since Medicaid is a state-administered program, the exact extent of Medicaid rehab coverage will depend on where you live. Medicaid provides health coverage for drug and alcohol addiction, and the state’s Medicaid program ensures access to mental health and substance abuse treatment services.

According to Medicaid policy guidelines, Medicaid addiction treatment must cover:

1. Medication-Assisted Treatment: This is the use of special medications to treat SUD’s like opioid addiction. MAT drugs covered include methadone, buprenorphine, and naltrexone. Every state will cover buprenorphine and naltrexone; methadone is covered in 42 of 53 states and territories.

2. Some form of counseling: There is flexibility here, but generally, all state Medicaid plans will cover some form of individual and group therapy. Medicaid covers disorder treatment for both drug abuse and alcohol addiction, and this coverage includes both inpatient and outpatient rehab. Medicaid will cover the cost of medically necessary treatment for addiction, including both inpatient and outpatient services.

Within the state of New Jersey, Medicaid rehab services include:

• MAT

• Inpatient Treatment (including for co-occurring mental health issues)

• Outpatient Treatment

• Withdrawal Management

Many rehab centers across different states accept Medicaid and may require pre-authorization before treatment begins. Rehab centers that accept Medicaid may offer a range of services, including inpatient and outpatient care, and you should verify with your Medicaid provider and the rehab center. You should submit any required documentation to both your Medicaid provider and the rehab center to process your coverage.

Medicaid is a government program for low-income people, elderly adults, children, pregnant women, and people with disabilities, and eligibility is based on income and household size. Individuals typically must have low income and limited assets (often around $2,000) to qualify for Medicaid rehabilitation services. Medicaid is a federally funded, state-run program designed to connect low-income people with healthcare services. Medicaid typically involves lower costs than private insurance and covers a wide range of essential healthcare services, but private insurance may offer more plan options and flexibility in provider choice. Medicaid generally does not cover non-clinical luxury amenities or recreational activities not connected to medical goals. Inpatient and residential rehab provide round-the-clock medical care and supervision, and coverage may depend on state-specific regulations regarding Institutions for Mental Diseases (IMD). Under the Affordable Care Act, mental health and substance use disorder services are considered essential health benefits that Medicaid must cover. Kentucky Medicaid covers a variety of services at inpatient and outpatient facilities, and provides coverage for substance use disorder treatment at little or no cost depending on need.

Medicaid is often not accepted by private treatment providers for various reasons. The Medicaid program has made efforts to improve Medicaid acceptance.

Medicaid addiction treatment eligibility varies by state but generally includes:

• Low-income individuals and families

• Pregnant women

• People with disabilities

• Elderly adults

• Children and young adults under the Children’s Health Insurance Program (CHIP; known in New Jersey as NJ FamilyCare)

• Some seniors who qualify for dual Medicare-Medicaid coverage

• Those under 19 years of age

• Single parents

Individuals typically must have low income and limited assets (often around $2,000) to qualify for Medicaid rehabilitation services. To determine whether you are eligible for Medicaid, you can apply through your state’s Medicaid office or use online tools provided by healthcare websites.

Per the ACA, to be eligible for Medicaid addiction treatment, you must have an income 133 percent or more below the federal poverty line. A person living over the poverty line may still be eligible for government insurance if they fall into the appropriate income group.