Does Medicaid Cover Outpatient Rehab in New Jersey?

Medicaid provides health insurance coverage to low-income individuals and people with disabilities. While Medicaid, like all other health insurance companies, does cover outpatient rehab, the exact amount of coverage each person has depends on where they live and which services they qualify for. When compared to private health insurance companies, Medicaid plans provide extremely expansive coverage for mental and behavioral health services.

If you or a loved one struggles with addiction and are covered by Medicaid, your health insurance may cover most or all of the costs of outpatient drug rehab in New Jersey.

What is Medicaid and Who is Eligible?

Medicaid is a public health insurance program that provides affordable coverage to eligible low-income adults and people with disabilities. Children who qualify for Medicaid are covered under the program’s Children’s Health Insurance Program (CHIP). As of April 2021, more than 82 million Americans were enrolled in Medicaid or CHIP.[1]

These programs are funded by both state and federal governments, so each state’s Medicaid program is unique. Each state is responsible for outlining its specific plans as well as the type, amount, and scope of services that are covered.

Federal law requires states to provide insurance coverage for low-income families and people with disabilities. People must make less than 100-200% of the federal poverty level AND meet one of the following qualifications:

• Younger than 19 years old
• Older than 65 years old
• Disabled
• Pregnant
• Parent or caretaker of a child

Will Medicaid Pay for Outpatient Rehab in New Jersey?

In most circumstances, Medicaid will cover most or all of the total cost of outpatient drug rehab in New Jersey. In fact, Medicaid has comprehensive behavioral health coverage and is the single largest payer for mental health services in the United States.[2] This is because the 2008 Mental health Parity and Addiction Equity Act (MHPAEA) required that Medicaid coverage for mental health and addiction be just as comprehensive as the coverage that is offered for other medical conditions.

If you are covered under Medicaid, it’s likely that you won’t have co-payments for addiction treatment. And, if you are in a state which does charge co-payments, you probably have a low out-of-pocket maximum that you can meet before your plan covers 100% of services. Additionally, the amounts you are responsible for paying may vary depending on your income.

It’s important to note that some states may be able to incorporate other costs like coinsurance, copayments, and deductibles on both inpatient and outpatient programs. Even if your Medicaid plan doesn’t cover the total cost of outpatient rehab, it will make treatment more affordable and attainable.

What Additional Services Does Medicaid Cover?

In addition to outpatient drug and alcohol rehab, Medicaid also covers all or part of the following services:

• Mental health screenings
• Treatment medications
• Family counseling
• Inpatient rehab
• Extended-care programs
• Medical detox
• One-on-one counseling sessions

How to Apply for Medicaid to Get Your Outpatient Rehab Costs Covered

If you are in need of addiction treatment and think you may qualify for Medicaid, it’s important that you get your application sent in as soon as possible. It can take weeks or months to get approved, and even longer for your coverage to begin, so it isn’t something that can wait if you don’t currently have health insurance.

You can apply for Medicaid at any time through your state’s Medicaid website or through the Health Insurance Marketplace. You must provide documentation to prove that you meet your state’s requirements for coverage. Documents you may need include:

• Birth certificate
• Driver’s license
• Pay stubs
• Latest tax return
• Proof of residency
• Bank statements
• Medical records

Each state has 45 days to process your application (90 days if you have a disability that must be confirmed.) If your application is denied, you may apply for a subsidized plan through the federal Health Insurance Marketplace. Both Medicaid and other plans sold through the marketplace are required to provide coverage for outpatient rehab in New Jersey.

How to Verify Your Medicaid Benefits for Outpatient Rehab

Medicaid health plans are now accepted at many addiction treatment centers in New Jersey. Before choosing an outpatient program, however, it’s important to verify your benefits with your insurance company and the rehab facility you are interested in. There are two ways you can do this:

1. Call the number on the back of your insurance card to speak with an agent about your benefits
2. Contact the addiction treatment center of your choice and have an admissions counselor verify your insurance benefits for you

Knowing exactly what services are covered and for how long can help you choose the most affordable treatment program near you.

Find an Outpatient Rehab in New Jersey That Accepts Medicaid Today

Figuring out how you’re going to pay for substance abuse treatment in New Jersey can be complicated and overwhelming, but our team is here to make the process a little bit easier on you. When you call one of our trusted addiction specialists, he or she will learn about your situation, verify your insurance benefits, and help you find a rehab center that meets your needs. Call now to get started.

References:

1. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html
2. https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/index.html