Alcohol & Health
Treatment
Helping Alcoholics
Medically Reviewed by Dr P. E. Pancoast, MD
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Medi-Cal is the Medicaid program for California residents. It covers various addiction treatment services, including alcohol rehab.
However, your coverage may vary depending on the county you live in. The main factors influencing your Medi-Cal rehab coverage are:
Understanding the essential health benefits of your rehab journey is important. Below we’ll discuss these benefits and other important topics regarding Medi-Cal.
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These are defined under the Affordable Care Act as services all health plans must cover without any yearly or lifetime dollar limits. These include substance abuse treatment services like:
All Medi-Cal plans include essential health benefits.8 However, only some Medi-Cal plans participate in the Drug Medi-Cal Organized Delivery System (DMC-ODS).
DMC-ODS is a pilot program to significantly expand Medi-Cal’s substance addiction treatment coverage. It provides access to various evidence-based practices and services that treat addiction.
These include:
The most recent available data shows that 37 of 58 California counties are implementing these expanded services. Those counties account for 96% of Medi-Cal recipients, meaning most enrollees are eligible for this coverage.2
If you receive treatment at a DMC-ODS-certified treatment center, you won’t have to pay any copay or deductible if you have Medi-Cal. However, as with any health insurance, the type of treatment you receive and the length of stay may lead to out-of-pocket expenses.
For example, counties participating in DMC-ODS may cover up to 90 days of residential treatment. This can be extended twice in one year. Anything beyond that won’t be covered.16
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Medi-Cal provides coverage for various addiction treatment services for alcohol and other substance use disorders. This can significantly reduce the cost of alcohol rehab.
However, even if you’re confident in your coverage, it’s important to know how much alcohol rehab costs. This can vary widely depending on the type of treatment and the specific rehab center.
A for-profit treatment facility is generally more expensive and has amenities like pools or saunas. Some are considered luxury rehab centers that are located on mountains or beaches.
On the other hand, non-profit rehab centers provide residential care or “inpatient treatment” and specific treatment programs. They offer basic amenities and comfortable living spaces.
The residential treatment cost at a for-profit facility can range from $6,000 for a 30-day stay, while others may be as high as $60,000.1 Meanwhile, non-profit treatment centers are more affordable with small enrollments.
Whether the treatment is inpatient or outpatient also significantly impacts cost:
Inpatient treatment involves 24/7 medical support and residential services, so it tends to be more expensive than outpatient treatment. Medication will increase treatment costs as well. For example, medication-assisted treatment (MAT) with naltrexone can cost up to $14,000 per year.14
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Medi-Cal covers various treatment services for alcohol addiction and other substance abuse issues. However, coverage for a small percentage of enrollees may be more limited.
Treatments include:
Detoxification is the first step in the alcohol and drug rehab process. It involves stopping all drinking so your body can return to normal. Medical detox can be performed by treatment providers to reduce the effects of alcohol withdrawal symptoms.
The initial assessment in a treatment program will determine the level of medical support needed during withdrawal. This varies from person to person.
Medi-Cal covers hospital stays and assistance from the hospital staff in detoxing. Withdrawal management is covered for a maximum of 7 days.15
Inpatient treatment involves around-the-clock medical supervision in a residential or hospital-type setting. Those suffering from severe alcoholism usually begin their treatment here, later moving to outpatient care.
This type of treatment can be beneficial to people who:
All Medi-Cal recipients are covered for inpatient treatment, and most are for residential treatment. Those in DMC-ODS counties may receive up to 90 days of coverage for residential treatment. This coverage can be extended once every one-year period (180 days in total).16
Outpatient treatment is less intensive than inpatient treatment. It consists of scheduled therapy sessions during parts of the day and unsupervised activities between each session.
Treatment may involve just a few sessions a week. Those who attend return home when their sessions are done.
Outpatient treatment includes intensive outpatient treatment (IOP) and partial hospitalization programs (PHP). All Medi-Cal enrollees are covered for outpatient treatment and IOP; most are for partial hospitalization.
Medication-assisted treatment (MAT) involves taking medication to manage withdrawal symptoms during detox. It’s usually combined with counseling to reduce cravings and prevent relapse.
Three drugs are FDA-approved for MAT to treat alcohol abuse:
Medi-Cal covers naltrexone for rehab as an essential health benefit.2 It’s a medication that helps manage cravings and prevent relapse.2
Substance abuse and mental illness often exist in a complex relationship known as a dual diagnosis. A mental health problem can lead to substance abuse. However, it can also result from an addiction.
United Healthcare plans cover mental illness linked to substance abuse. Some mental health disorders linked to alcoholism include:
All Medi-Cal plans will cover the cost of counseling or medication to treat an addiction-related mental illness. It’ll also cover any evidence-based therapy for rehab, including:14
To be eligible for Medi-Cal, you must:
You can also qualify if you’re:
Being on the following programs also qualifies you for Medi-Cal:
If you want to check for yourself what will or won’t be covered by Medi-Cal, you can call the Medi-Cal Helpline at (800) 541-5555.9 The helpline is open Monday to Friday from 8 AM to 5 PM (excluding holidays).
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