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Sadly, it is estimated that 105 people die every day as a result of drug overdose.1Dual diagnosis treatment centers and rehab programs near me. Drug Rehab Options. (2022, April 22). Retrieved from https://rehabs.com/dual-diagnosis-rehabs/Substance use disorders One can’t help but wonder how many of these deaths could have been prevented with proper treatment. Recent statistics show that only 10% of sufferers of addiction actually get the help they need.2The 3 Biggest Reasons People Don’t Seek Help For Addiction. (2016). Retrieved from https://vertavahealth.com/blog/the-3-biggest-reasons-people-dont-seek-help-for-addiction/ Likely reasons for why those with substance abuse disorders don’t get proper help include fear of what others might think or denial of their condition. Another reason treatment is not received may be lack of access, or rather, people not knowing their treatment options. The good news is everyone in the U.S. has access to treatment. If you don’t have private health insurance to cover the costs, then Medicaid is your gateway to a life free of addiction. 

What is Medicaid?

Medicaid is a public health insurance program offered from the government for low-income families. It was created in 1965 and is state-managed, with 1 in 5 Americans being covered under the program, regardless of how much or costly care they need.310 Things to Know about Medicaid: Setting the Facts Straight. (2019). Retrieved from https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/#:~:text=Medicaid%20is%20the%20nation%E2%80%99s%20public%20health%20insurance%20program,principal%20source%20of%20long-term%20care%20coverage%20for%20Americans.

Under the 2010 Affordable Care Act (ACA), or “Obamacare,” Medicaid covers a broad range of health services to address those with the coverage. Expansion of the program from Obamacare allowed for wider eligibility for those with low income.4Id. Many states have even elected to offer additional services that include prescription drugs, physical therapy, eyeglasses, and dental care.510 Things to Know about Medicaid: Setting the Facts Straight. (2019). Retrieved from https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/#:~:text=Medicaid%20is%20the%20nation%E2%80%99s%20public%20health%20insurance%20program,principal%20source%20of%20long-term%20care%20coverage%20for%20Americans. 

Mandatory health benefits from Medicaid include:

Who is Eligible For Medicaid in Kentucky? 

Since February 2022, Kentucky has enrolled roughly 1.5 million people in Medicaid and the Child Health Insurance Program (CHIP)—a substantial increase in beneficiaries through the last decade.7Kentucky | Medicaid. (2022). Retrieved from https://www.medicaid.gov/state-overviews/stateprofile.html?state=kentucky 8Children’s Health Insurance Program (CHIP) Eligibility Requirements. (2022). Retrieved from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/

In order to understand eligibility requirements for Medicaid, it is necessary to first know how eligibility is calculated. With Medicaid being health insurance for those with low-income, a metric known as the federal poverty level (FPL), is used to determine what income levels constitute eligibility. 

In states that have expanded Medicaid, Americans under the age of 65 will qualify if they earn up to 138% of the (FPL).9federal poverty level | healthinsurance.org. (2022). Retrieved from https://www.healthinsurance.org/glossary/federal-poverty-level/#:~:text=2022%20Federal%20Poverty%20Guidelines%20%20%20%20Persons,%20%20%2431%2C920%20%205%20more%20rows%20 In states that have not expanded under the (ACA), income must be 133% or less of the federal poverty level. For people over the age of 65, Medicaid eligibility also depends on assets with metrics that vary state by state. 

Fortunately for those living in Kentucky, Medicaid was expanded in 2014. This means households with income up to 138% of the (FPL) can qualify. In 2022, the level is $13,590 for a single person. For example, a single adult could earn up to $18,754 per year to be able to receive Medicaid.10Federal Poverty Level. healthinsurance.org. (2022, May 11). Retrieved from https://www.healthinsurance.org/glossary/federal-poverty-level/#:~:text=2022%20Federal%20Poverty%20Guidelines%20%20%20%20Persons,%20%20%2431%2C920%20%205%20more%20rows%20  

It is important to know the (FPL) increases per number of people in a household. For a family of four, the amount is $27,750, meaning the gross household income could be $38,295 or less to qualify for Medicaid in Kentucky. 

Additional situations for Medicaid eligibility, in Kentucky are as follows (expressed as percentage of federal poverty level):11Kentucky | Medicaid. (2022). Retrieved from https://www.medicaid.gov/state-overviews/stateprofile.html?state=kentucky

  • For pregnant women, 195% 
  • For ages 0-1, 195%
  • For ages 1-5, 159%
  • For ages 6-18, 159%
  • For parent, caretaker, 22%($)

Are There Limits On This Health Plan Coverage For Rehab?

Medicaid covers all the basic aspects of drug and alcohol dependency recovery. However, medicaid puts limits on the amount of covered services per year in some categories of treatment. 

For example, medicaid coverage typically caps how many days a patient be covered at an inpatient treatment center. This cap is usually between 30 to 60 days.12Does Medicaid Cover Rehab? | New Day Recovery. (2022). Retrieved from https://newday-recovery.com/blog/does-medicaid-cover-rehab/ There may also be limits on how many hours of outside therapy are covered per week. 

Medicaid does not have limits with all types of treatments, though. It is important to remember Medicaid offers broad and effective coverage for a variety of addiction treatments.

A vital note on Medicaid for addiction treatment is that not all rehab centers and care providers accept Medicaid as payment. However, there is no need to be discouraged, because there are great substance abuse rehabilitation centers that do. In Kentucky, The Commitment House is one of them. 

Can I Use Medicaid as a Secondary Insurance in Addition to Other Insurance Options? 

The two broad categories of health insurance are those provided and managed by the government, such as Medicaid or Medicare. Then there is healthcare provided by private companies, like Humana or Aetna, known as commercial health insurance.13Commercial Health Insurance. (2022). Retrieved from https://www.thebalance.com/what-is-commercial-health-insurance-5214855

Whether you have Medicare or commercial health insurance, you may wonder if Medicaid can be used to supplement costs as a secondary insurance. Well, yes, Medicaid can work as either a primary or secondary insurer. 

If you are enrolled in both Medicare and Medicaid, then you are considered a dual eligible beneficiary.14Glossary of Terms Related to Dual-Eligible Beneficiaries of Medicare and Medicaid | Congressional Budget Office. (2013). Retrieved from https://www.cbo.gov/publication/44309 These beneficiaries qualify for full Medicare benefits, with Medicaid picking up most other costs that Medicare might not fully cover.

If you have private health insurance, Medicaid works as the “last resort,” meaning it will be the last plan to contribute as payment of medical bills.15Medicaid as Secondary Insurance | How Medicaid Works With Medicare and Other Coverage. (2022). Retrieved from https://www.medicareadvantage.com/medicaid/medicaid-as-secondary-insurance Other plans that might be ordered to pay for care before Medicaid include group health or self-insured plans. 

Does Medicaid Cover Addiction Treatment? 

Medicaid certainly covers a variety of different addiction treatment options. In Kentucky, Medicaid can be used for addiction treatment services like detox, outpatient rehab, and many more. It is a viable and practical option for addiction treatment. 

When using Medicaid or other health insurance plans, it is important to know what premiums and copayments are.16Medicaid FAQ Sheets – Medicaid-help.org. (2022). Retrieved from https://medicaid-help.org/faqs/kentucky/#:~:text=Medicaid%20recipients%20in%20Kentucky%20may%20need%20to%20pay,cost%20for%20treatments%2C%20which%20are%20known%20as%20copayments Monthly premiums are monthly fees to pay for enrollment in the program and can range from $1 to $15. 

Small out-of-pocket treatment costs are known as copayments. For example, a copayment for an inpatient addiction treatment center may be $50 per day. This is an expense to keep in mind. It is also important to remember how affordable this copayment is, rather than facing thousands of dollars of costs without insurance. 

As previously mentioned, there are some limitations to what and how long Kentucky Medicaid covers for addiction treatment. But if you need longer or more thorough services that Medicaid will not cover, there are solutions. 

To finance the rest of your recovery program after Medicaid, you can use:

  • Federal or state grants
  • Scholarships from drug rehab center
  • Sliding fee scale payment options 
  • Other savings
  • Or flexible payment schedules with realistic options from willing centers like The Commitment House

Types of Substance Abuse Treatment That Medicaid Covers 

Medicaid offers far-reaching benefits for addiction treatment in Kentucky. This exhaustive list of treatment options17Behavioral Health and Substance Use Disorder. Kentucky Cabinet for Health and Family Services. (n.d.). Retrieved from https://chfs.ky.gov/agencies/dms/member/Pages/SubstanceAbuse.aspxfor substance abuse include, but are not limited to: 

  • Screening, assessment, and testing
  • Dual diagnosis treatment for co-occurring disorders
  • Mobile, immediate crisis intervention
  • Day treatment for adults and children
  • Intensive outpatient program/therapy
  • Peer support
  • Prescription drugs
  • Family services

It is best to speak with a healthcare provider or local, Medicaid-accepting treatment center for a full list of treatment services offered to you. 

Does Commercial Insurance Cover Rehab In Kentucky? 

Treatment for drug and alcohol rehabilitation is covered by commercial health insurance. The Affordable Care Act lists rehab services for substance abuse treatment as an essential health benefit18Insurance coverage for Drug and alcohol rehab treatment. Drug Rehab Options. (2022, June 14). Retrieved from https://rehabs.com/insurance-coverage/; therefore, all insurance sold on the Health Insurance Marketplace must cover addiction treatment. 

In addition, insurance companies cannot deny coverage for any pre-existing conditions like substance use or mental health disorders. Insurance companies cannot even deny health insurance for those with dual diagnosis, which is when drug addiction occurs in someone with a mental health condition. 

If someone is seeking commercial health insurance to cover the costs of addiction treatment, it is important to understand there are plans available regardless of pre-existing conditions. 

The Commitment House Is Here To Help 

At The Commitment House substance abuse treatment center, we believe in a person-centered approach for long-term sobriety from addiction and substance abuse. With our focus on changing the lives of people and how they think, we are confident in providing you with the best treatment options for sobriety from drug and alcohol dependency.

We pride ourselves on accepting Medicaid, as well as other health insurance plans. Let us help you achieve lifelong sobriety. We are committed to you. Contact Us or give us a call at 270-900-0373 today!

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