Alcohol & Health
Treatment
Helping Alcoholics
Where Does My Call Go?

Medi-Cal Insurance For Addiction Treatment

Written by 

Does Medi-Cal Cover Alcohol Rehab?

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:

  1. Essential health benefits (all Medi-Cal plans cover these)
  2. Drug Medi-Cal Organized Delivery System (only some Medi-Cal plans are included here)

First, it’s important to understand what essential health benefits are. 

man leading group therapy
ALCOHOL REHAB HELP

Looking for a Place to Start?

An addiction specialist can help answer your questions and guide you through the intake process.

Essential Health Benefits

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:

  • Outpatient treatment
  • Preventative screenings
  • Intensive outpatient treatment
  • Hospitalization
  • Residential treatment for perinatal women
  • Voluntary detoxification in a hospital
  • Inpatient treatment for substance use disorder 
  • Counseling and therapy for any related mental health issues
  • Medications to treat mental illness
  • Medication-assisted treatment

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

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. 

These include:

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

Man meditating at home
ALCOHOL REHAB HELP

Thinking about Getting Help?

Addiction specialists are available 24/7 to answer questions about costs, insurance, and payment options.
Learn More

Cost of Alcohol Rehab

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:

1. Type of Facility

An alcohol rehab facility can be either for-profit or non-profit. A for-profit treatment facility is usually more expensive.

Here’s why:

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. 

2. Type of Treatment

Whether the treatment is inpatient or outpatient also has a significant impact on cost:

  • Outpatient treatment costs $32 to $385 per week, on average.11
  • Inpatient treatment typically costs thousands per week.

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

Insurance Can Help Pay for Addiction Treatment

Call now to speak with a specialist about your insurance benefits.

Which Treatments Does Medi-Cal Cover?

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.

Treatments include:

Detoxification

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 Coverage for Detoxification

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

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.

Medi-Cal Coverage for Inpatient Treatment

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

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). 

Medi-Cal Coverage for Outpatient Treatment

All Medi-Cal enrollees are covered for outpatient treatment and IOP, and most are covered for partial hospitalization.

Medication-Assisted Treatment (MAT)

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:

  1. Acamprosate (Campral)
  2. Disulfiram (Antabuse) 
  3. Naltrexone (Vivitrol)

Medi-Cal Coverage for Medication-Assisted Treatment (MAT)

Naltrexone is covered by Medi-Cal for alcohol rehab to manage cravings and to prevent relapse.2 

Mental Health Treatment

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. 

Medi-Cal Coverage for Mental Health Treatment

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.

Am I Eligible for Medi-Cal DMC-ODS?

To be eligible for Medi-Cal, you need to:

  1. be a resident of California 
  2. have an income at 138% below the federal poverty level (currently $17,609)

You can also qualify if you’re:

  • Age 65 or older
  • Blind
  • Disabled
  • Pregnant
  • Under 21 years of age
  • In a skilled nursing facility
  • A refugee
  • Have been screened for breast or cervical cancer
  • A parent or guardian of an eligible child

Being on the following programs also qualifies you for Medi-Cal:

  • CalFresh
  • SSI/SSP
  • CalWorks (AFDC)
  • Refugee Assistance
  • Foster Care

How to Check Your Medi-Cal Rehab Coverage 

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).

Begin your journey towards lasting recovery
Call us (866) 928-4133
Updated on May 17, 2022
17 sources cited
  1. Beetham, Tamara. “Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US.” Health Affairs, vol. 40, no. 2, 2021.
  2. California Health Care Foundation. “Drug Medi-Cal Organized Delivery System.” 2018.
  3. Covered California. “Medi-Cal.www.healthforcalifornia.com.
  4. DEPARTMENT OF HEALTH CARE SERVICES. “Counties Participating in DMC-ODS.www.dhcs.ca.gov.
  5. DEPARTMENT OF HEALTH CARE SERVICES. “​Do You Qualify for Medi-Cal Benefits?www.dhcs.ca.gov.
  6. DEPARTMENT OF HEALTH CARE SERVICES. “​​​​​​​Drug Medi-Cal Overview.www.dhcs.ca.gov.
  7. DEPARTMENT OF HEALTH CARE SERVICES. “​​​​​​​​​​​​​​​Medi-Cal Eligibility & Covered California - FAQ's.” www.dhcs.ca.gov.
  8. DEPARTMENT OF HEALTH CARE SERVICES. “​​​MEDI-CAL EXPANSION: COVERING MORE CALIFORNIANS.www.dhcs.ca.gov.
  9. DEPARTMENT OF HEALTH CARE SERVICES. “Medi-Cal Member and Provider Helpline.www.dchs.ca.gov.
  10. French, Michael T. “The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement.” Journal of substance abuse treatment, vol. 35, no. 4, 2008, pp. 462-9. www.ncbi.nlm.nih.gov
  11. HealthCare.gov. “Mental health & substance abuse coverage.www.healthcare.gov.
  12. HealthCare.gov. “What Marketplace health insurance plans cover.www.healthcare.gov.
  13. Kaskutas, Lee Ann. “Costs of day hospital and community residential chemical dependency treatment.” The journal of mental health policy and economics, vol. 11, no. 1, 2008, pp. 27-32. www.ncbi.nlm.nih.gov.
  14. National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Behavioral Therapies.nida.nih.gov, 2018.
  15. OC Healthcare Agency. “DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS).www.ochealthinfo.com.
  16. Richmond, Linda. “States Pilot New Medicaid Substance Use Treatment Plans.psychnews.psychiatryonline.org, 2017.
  17. UCLA Integrated Substance Abuse Programs. “California’s Drug Medi-Cal Organized Delivery System.” Department of Health Care Services California Health and Human Services Agency, 2018.

Find your treatment that works for you!

All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.

This site complies with the HONcode standard for trustworthy health information:Verify here.

© 2022 by Treatment Pathway LLC. All rights reserved.
Back to top icon
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram