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Medi-Cal is the Medicaid program for the State of California. All Medi-Cal health plans cover some form of alcohol rehab, but there may be differences depending on the county you live in.
The two main factors influencing your Medi-Cal alcohol rehab coverage are:
First, it’s important to understand what essential health benefits are.
These are defined under the Affordable Care Act as services all health plans must cover without any yearly or lifetime dollar limits.
For alcohol rehab, these include:
All Medi-Cal plans include essential health benefits.8
However, only some Medi-Cal plans participate in the Drug Medi-Cal Organized Delivery System (DCM-ODS).
DCM-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.
As of the most recent available data, 37 of 58 California counties are implementing these expanded services. Those counties account for 96% of Medi-Cal recipients, meaning the majority of enrollees are eligible for this coverage.2
Most Medi-Cal recipients won’t have to pay any copay or deductible if they receive alcohol rehab at a program certified by Drug Medi-Cal (DCM-ODS). However, as with any health insurance, treatment type and length may lead to out-of-pocket expenses.
For example, counties participating in DCM-ODS may cover up to 90 days of residential treatment. This can be extended twice in a one-year period. Anything beyond that won’t be covered.16
Even if you’re confident in your coverage, it’s important to know how much alcohol rehab costs.
This can vary widely depending on two main factors:
An alcohol rehab facility can be either for-profit or non-profit. A for-profit treatment facility is usually more expensive.
For-profit rehab centers generally have more or better amenities, like pools or saunas. They may also be in nicer locations, like in the mountains or on a beach. Because of this, they tend to market themselves as "luxury" rehabs for wealthier clients.
Non-profit rehab facilities that provide residential care or ‘inpatient treatment’ usually only offer specific treatment programs. They add in the basics: a room with a bed, a bathroom, a place to store your possessions, and sometimes a television.
Medi-cal is more likely to approve coverage for these facilities. Most rehab facilities focus on outpatient care.
A for-profit treatment facility might cost up to twice as much as a non-profit facility. One study of residential treatment programs found the average difference in monthly fees between the two to be $17,434 to $5,712.1
Non-profits with larger enrollments are likely to be more affordable than those with small enrollments. Studies show treatment centers with large enrollment numbers charge less per person.
Note: Treatment success is not dependent on whether you attend a ‘luxury’ or less expensive facility. Both treatments have been shown to be effective.
Whether the treatment is inpatient or outpatient also has a significant impact on 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 cost as well. For example, medication-assisted treatment (MAT) with naltrexone can cost up to $14,000 per year.14
Note: Medi-Cal covers naltrexone for alcohol rehab as an essential health benefit.2
Medi-Cal covers a variety of treatments for alcohol addiction and other substance abuse issues. However, coverage for a small percentage of enrollees may be more limited.
Detoxification is the first step in the alcohol rehab process. Also known as detoxing, it involves stopping all drinking so your body can return to normal. The process can be frightening, as it can lead to withdrawal symptoms.
Since alcohol withdrawal can be deadly, the best way to detox is with professional help, known as medical detox.
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 alcohol rehab involves around-the-clock care and support in a residential or hospital-type setting. Those suffering from severe alcoholism usually begin their treatment here, later moving to outpatient care.
People who are homeless, or have very poor social support systems, may need inpatient care initially to stay abstinent.
All Medi-Cal recipients are covered for inpatient treatment, and most are covered for residential treatment.
Those in DCM-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.
People with mild alcohol use disorders (AUDs) benefit from outpatient treatment.
Included within outpatient treatment are intensive outpatient treatment (IOP) and partial hospitalization programs (PHP).
All Medi-Cal enrollees are covered for outpatient treatment and IOP, and most are covered 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:
Naltrexone is covered by Medi-Cal for alcohol rehab to manage cravings and to 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:
It's essential to treat any dual-diagnosis with addiction and mental illness at the same time.
All Medi-Cal plans will cover the cost of any counseling or medication to treat a mental illness related to an addiction.
Medi-Cal will also cover any therapy for alcohol rehab that is evidence-based. This means any therapy with scientific evidence for its efficacy.
According to the Department of Health and Human Services (which is responsible for Medicaid), this includes:14
Keep in mind: The cost of addiction is often many times that of a successful treatment program.
To be eligible for Medi-Cal, you need to:
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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