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MassHealth Insurance For Addiction Treatment

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Does MassHealth Cover Drug & Alcohol Rehab?

MassHealth is the name of Massachusetts’s state Medicaid program. Both Medicaid in Massachusetts and the Children’s Health Insurance Program (CHIP) are a part of MassHealth.

Aside from being a medical provider, care may also come from: 

  • Primary care providers
  • Doctors
  • Specialists
  • Hospitals
  • Addiction treatment practitioners
  • Other medical institutions and facilities 

Alcohol and substance abuse treatment services are more accessible to members through MassHealth insurance. It provides coverage for the following:

  • Medical services
  • Behavioral health care (via Massachusetts Behavioral Health Partnership)
  • Dental care
  • Other long-term services

These treatment services are tailored to a person’s specific needs. 

Cost of Drug & Alcohol Rehab

The costs associated with drug and alcohol rehab vary. Factors that influence rehab cost include:

1. Type of Treatment Facility

Inpatient treatment generally costs more than outpatient treatment. This is due in part to lodging costs at inpatient facilities and the 24 hour on-site medical care availability. 

Meanwhile, people in outpatient treatment live at home, which makes care more affordable. 

Inpatient facilities cost up to $20,000 for a 30-day program. Outpatient programs cost around $5,000 for a 3-month program.

2. Type of Treatment

Most inpatient rehabs also incorporate medical detox in the program cost. The exact cost of detox depends on: 

  1. The type of drug addiction
  2. Whether or not it’s part of an inpatient program

3. Underlying Medical Conditions

Having a concurrent mental health disorder and substance use disorder is called dual diagnosis

Drug and alcohol abuse can also increase the risk of medical conditions. Examples include liver damage and mental health disorders such as: 

  • Depression
  • Anxiety
  • Attention deficit disorder (ADD)

Underlying medical conditions can increase addiction treatment costs by several thousand dollars a year. This varies by condition and addiction types.

4. Level of Support from Friends and Family

Family and friends can help their loved one achieve and maintain sobriety. Their role in helping monitor symptoms and preventing relapse is significant. 

The person may want to include their support system in some therapy sessions. This occurs as deemed necessary by the healthcare provider.

By attending therapy sessions with their loved one, friends and family can gain awareness of their condition. They can learn how to help optimize their treatment results. 

Medicaid and the Children’s Health Insurance Program can also help with treatment costs.

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Which Treatments Does MassHealth Cover?

Just as there are different types of addiction, there are also various forms of medication and treatment plans. 

MassHealth covers the following:

1. Medical Detox

Physical dependence is the body’s natural adaptation to drug or alcohol intake. Once the body builds tolerance, it requires the drug to function normally. 

Detoxification (detox) clears the body of drugs or alcohol. It may consist of medication-assisted treatment (MAT).

This treatment aims to manage withdrawal symptoms once drugs and/or alcohol use stops or slows downs. 

Side Effects of Detox

Detox can produce withdrawal symptoms like:

  • Changes in appetite and mood
  • Fatigue
  • Muscle pain
  • Congestion
  • Nausea

In some cases, withdrawal can be life-threatening without medical supervision and care. 

How Long Does Detox Take?

The length of detox can vary based on several factors. These include: 

  1. The type of substance the person is addicted to
  2. The duration of their drug use
  3. Their medical history
  4. Any underlying medical and/or psychological conditions they have

2. Inpatient Treatment

Also known as residential treatment, inpatient treatment is a multi-faceted approach. It integrates the following in a controlled environment: 

  • Medical detox
  • Mental health assessments (e.g., therapy and counseling)
  • Addiction treatment services 

Basic inpatient rehab treatment facilities include: 

  • Shared rooms
  • Cafeteria 
  • Recreational activities like swimming, gym exercise, and group and individual sports
How Long Does Inpatient Treatment Take?

The average stay is 30 days. However, some treatment facilities offer programs that last for as long as 90 days. If someone needs more time to recover, additional treatments are available. 

People without stable home environments, or whose family or roommates routinely use drugs and alcohol, will have a very difficult time abstaining if they are living at home.

3. Outpatient Treatment 

Mild substance use disorders (SUDs) can benefit from outpatient rehab programs. 

Similar to inpatient treatment, outpatient treatment includes:

  • Counseling
  • Therapy 
  • Support group discussions 

This helps people cope and overcome their addiction. But because the person is not admitted to a treatment center, activity schedules tend to be more flexible.

How Long Does Outpatient Treatment Take?

Usually, doctors advise patients to visit their local treatment center 4 to 5 days per week for 1 to 2 hours per session. 

There is no fixed time for this type of treatment. Healing time greatly depends on the person’s time commitment and discipline, as well as their home environment. 

It is also essential to note that this program is limited to the person’s schedule, whether they are working or in school for the duration of the program. 

4. Intensive Outpatient Programs (IOPs)

Intensive outpatient programs (IOPs) are similar to outpatient treatments, but require more frequent visits to the treatment center each week. Some IOPs require seven visits per week. 

IOPs are ideal for people who have safe home environments and family and friends who can support them throughout treatment. 

In times of severe withdrawal symptoms or relapse, people in IOPs may switch to residential treatment, per a recommendation from their doctor.

5. Partial Hospitalization Programs (PHPs)

Partial hospitalization programs (PHPs) provide a high level of care for people with substance use disorders (SUDs). PHPs do not require an overnight stay. 

These treatment programs often have similar intensities and daily structures as inpatient programs. Meetings usually occur for 4 to 6 hours a day. 

PHP services include:

How to Qualify for MassHealth Insurance

To qualify for MassHealth insurance, here are some of the requirements:

  • Social Security numbers for every household member who is applying
  • Citizenship certificate or national or immigration status
  • Income status and financial statements
  • Other health insurance that you are currently enrolled in or have access to

How to Apply 

Here are three ways to apply for MassHealth insurance: 

1. Online

To apply online, register and create an account at https://www.mahealthconnector.org/.

2. By Phone

Call the MassHealth Customer Service Center at (800) 841-2900. Their office hours are Monday through Friday, 8 am to 5 pm.

3. By Mail

Mail your application form to the following address:

Health Insurance Processing Center

PO Box 4405

Taunton, MA 02780

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How to Check Your MassHealth Coverage 

Certain members in the MassHealth program will need to enroll in a health plan. For information about MassHealth coverage, visit www.mass.gov/masshealth.

Updated on January 27, 2022

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