Medicaid Steps Up: Coverage Available for Inpatient Drug Rehab

Historically, it has sometimes been difficult to get insurance to cover the cost of inpatient drug rehabilitation programs. While all insurance companies are required to cover treatment services for drug and alcohol dependence, the specifics on what treatment services they must cover and under what circumstances are not clear. Thus, every insurance company – including Medicare and Medicaid – have notoriously given patients the runaround when it comes to getting coverage, especially for the most expensive option in addiction treatment: inpatient care.

A new plan under consideration by the Centers for Medicare and Medicaid Services would remedy this situation in part by providing coverage for 15 days worth of inpatient addiction treatment services every month. While 15 days is by no means long enough to provide comprehensive drug addiction treatment and care for anyone who needs intensive residential treatment, it would at least mitigate the cost significantly, making it easier for family members to cover another 15 days – and potentially benefit from 30 days of treatment for the out-of-pocket cost of 15 days.

How Have People Paid for Drug Addiction Treatment up until Now?

According to NPR, people who rely on Medicaid to cover the cost of medical care have been dependent upon funding from the state and local government agencies or other nonprofit sources to get the treatment they needed. Because there is limited funding available for this purpose, the results have been:

• Too few spots available in treatment programs and long waiting lists for those spots
• Barebones, one-size-fits-all treatment approaches with few resources that often result in clients “falling through the cracks”
• Priority given to court-ordered clients, creating an even longer waiting list for others to get treatment
• Many people overdosing before they are able to get help or returning to addiction when treatment is not sufficient to meet their needs

Why Is Getting Coverage So Difficult?

Money. It is no more complicated than the bottom line. Drug addiction treatment is expensive, and when those expenses include the cost of room and board plus round-the-clock staffing on top of all the necessary treatments, the total bill can be significant.

To be fair, the healthcare system is grossly mismanaged. Because so many are unable to pay for necessary medical care, providers are forced to charge exorbitant amounts for basic services to make up the difference. If you’ve ever seen a charge for $40 on your medical bill for a dose of acetaminophen that you received at the doctor’s office, then you have seen this problem in action. At the end of the day, insurance companies are for-profit businesses and, in order to stay in business, they must be sure that all covered medical services are medically necessary and provided for within the policy. Unfortunately, that fact can translate into a great deal of red tape and hassle at a time when fast and efficient answers are most necessary.

How Do I Know What Addiction Treatment Services My Insurance Company Will Cover?

Call them. You can look at the fine print on your policy and any sections that discuss the different types of services covered and in what amount, but there may have been updates and changes since you signed up according to requirements of state law. It will be easier to call and speak to someone in person to get details, then ask that they follow up with an email that puts into print the agreed-upon service coverage items and amounts. The more you know in advance of choosing a drug rehab program, the better able you will be to manage costs as they arise without being blindsided by unexpected bills.

Will the New Policy Help?

Certainly, any amount of treatment is better than none, but many question why and how the organization came upon the arbitrary number of 15 days of residential treatment. There is no evidence to suggest that this would be adequate to create any real and lasting change for the client or support long-term health in recovery. Some believe that, while the proposed policy is a good start in the right direction, it’s not enough. Longer covered stays would be necessary to ensure that those in need of care have access to uninterrupted treatment.

Additionally, because 15 days is not enough to stabilize someone with a history of addiction in a sober life, there is a concern that this will only be a waste of money in the long run, draining the resources necessary to support stronger changes.

There is also a concern that the new change will alter the ability of programs dependent upon government funds to be reimbursed for the costs associated with residential addiction treatment for stays longer than 15 days for some clients.

Even the National Institute on Drug Abuse (NIDA) supports the idea that adequate treatment length is necessary for positive outcomes in recovery after addiction. However, like many government standards regarding drug and alcohol treatment, the specifics – like how many days, weeks, or months add up to “adequate” – are not defined.

How Long Should a Residential Treatment Stay for Addiction Last?

All the details about addiction treatment must be determined on a case-by-case basis – which is why government regulations and insurance companies both refrain from getting too specific when talking about effective care. For one person, six months to a year in a residential treatment program will be necessary to stabilize in recovery. For another, outpatient addiction treatment is effective. To determine how long you should stay in treatment, find a drug rehab program that offers you the option to tailor your program according to your needs, then work with the treatment team to determine what those needs are.