The costs of addiction treatment often present a barrier to people who need drug treatment services. Insurance can help cover the cost of treatment services, but what if you can’t afford private insurance in California? As a California resident, you may have access to a program called Medi-Cal, which is a health insurance option for people with low-income levels and other issues. Learn more about Medi-Cal’s coverage of drug treatment services and how you can get treatment in California. 

Medi-Cal is a Medicaid program that’s specifically for residents of California. The program is supported by both federal

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 and state taxes and designated for children and adults who have limited financial resources and a certain level of need. Many people enrolled in Medi-Cal will not have to pay insurance premiums, co-pays, or out-of-pocket expenses. Some houses will have to pay low monthly premiums. 

Medi-Cal covers what is referred to as “essential health benefits.” But the Affordable Care Act (ACA), which was made effective in 2010, expanded what was considered essential health to include mental health, behavioral health, and substance use disorder treatment. New regulations made it so that insurers had to offer coverage for these services in order to participate in the health insurance marketplace in the U.S. 

Plus, new regulations also came with what is called parity laws, which make it so that insurers have to offer similar levels of coverage for mental and behavioral health services that they do for other forms of healthcare. In other words, insurance providers aren’t allowed to offer robust coverage for medical services like surgeries and bodily treatment and offer extremely limited coverage for mental health treatment. 

Medi-Cal covers various medical services that are considered essential health benefits, which include common medical treatments, procedures, and emergency services. Enrollment in Medi-Cal is designated for people with few financial options, so it offers fairly comprehensive coverage. 

  • Ambulatory services. This can include any procedures or medical care that take place in outpatient settings and don’t require admission to a hospital.  
  • Emergency services. This includes visits to the emergency room to address urgent medical needs.  
  • Hospitalization. This refers to admission to an inpatient setting and a stay in a hospital.  
  • Maternity and newborn care. This involves labor, birth, and medical care afterward for mothers and newborns. 
  • Mental health and substance use disorder services. This includes addiction treatment and behavioral health services. 
  • Prescription drugs. Medications that are prescribed to you to be a medical professional. This can include medications prescribed to treat mental health issues. 
  • Rehabilitative and habilitative services. This includes programs like physical and occupational therapy that are needed to rehabilitate you after an injury or medical complication. 
  • Laboratory services. Lab services are often used to diagnose or monitor medical issues. 
  • Preventive and wellness services and chronic disease management. This covers both routine checkups and long-term health care needs for treating chronic diseases.  
  • Pediatric services. Medical care for children, including oral and vision care. 

While routine and common medical needs are covered by Medi-Cal, there are a few things that aren’t covered, including some elective procedures, cosmetic surgery, artificial insemination, experimental services, infertility treatment, and some other specific services, items, and procedures. 

Addiction treatment often starts with inpatient services, especially for people who have severe substance use disorders and chemical dependence on a drug. If you have significant medical needs that need to be treated and monitored or if you’re likely to go through severe withdrawal symptoms, you will need inpatient services. Residential treatment also falls under the category of inpatient services. This may be ideal for people with stable medical conditions that need support to avoid relapse or other complications. This can include people who live in environments that could threaten their sobriety, like living with someone that still uses drugs. 

If you or someone you know is struggling with a substance use disorder and needs inpatient treatment, Medi-Cal offers coverage for the following:

  • Voluntary inpatient detoxification. Detox is the highest level of care in addiction treatment and involves 24-hour medically managed treatment. It’s often used to treat severe or dangerous withdrawal symptoms.
  • Inpatient specialty mental health services. In some cases, severe mental health needs require inpatient services to address them effectively. 
  • Residential SUD treatment services. Residential treatment for substance use disorders may include on-campus apartment-style living with 24-hour access to care. 

If you are a Medi-Cal member, you may qualify for Drug Medi-Cal, which is funding that is specifically for addiction-related treatment. This covers various services that are related to mental health and addiction treatment services, including outpatient services. Outpatient services are reserved for people with lower-level needs in addiction treatment but still require support and treatment to continue to pursue their recovery. 

Outpatient treatment is not for people with high-level medical or psychological needs, a high likelihood of severe withdrawal, a high risk for relapse of continued use, or a home environment that threatens their safety or sobriety. A qualified doctor or clinician can help you determine the right level of care for your needs. 

If outpatient treatment is right for your needs, Medi-Cal will cover the following: 

  • Outpatient mental health and specialty mental health services. Mental health and addiction are often related. Mental health issues can complicate and worsen substance use disorder. It’s important that both issues are addressed at the same time.
  • Outpatient substance use disorder services. Outpatient services allow you to live at home while you attend treatment during the day. There are multiple levels of outpatient treatment that depend on the amount of time you spend in treatment each week.

Through treatment, you may also be referred to outpatient medical services with a doctor or dentist that will also be covered by Medi-Cal.

Medication-assisted treatment (MAT) is an approach to treatment that involves the use of specific medications that are approved to treat substance use disorders. These medications are combined with psychotherapy and behavioral therapies to form a complete treatment plan. There are MAT medications available for the treatment of alcohol use disorder, but the majority of MAT treatment is used in opioid use disorders. MAT for opioid addiction involves the use of medications like methadone, buprenorphine, and naltrexone. MAT can be extremely helpful for people who have gone through addiction treatment before and relapsed, possibly several times. 

Medi-Cal does offer coverage for medication-assisted treatment. All three of the most common drugs that are used in MAT for an opioid use disorder are covered, including methadone, buprenorphine, and naltrexone. It also covers drugs for MAT for alcohol use disorder, including naltrexone, acamprosate, and disulfiram. However, Medi-Cal may not cover all forms of these drugs. These medications may be paired with other treatment services that are also covered by Medi-Cal.

You can get Medi-Cal coverage by applying at the Covered California website. Your application will be reviewed by your county’s human services department. Since Medi-Cal is reserved for people with a specific level of need in California, not everyone who applies will qualify. One of the biggest criteria is that you have to have an income that’s 138 percent or more below the federal poverty line. Medi-Cal is also available to people that meet the following criteria:

  • Age 65 or older
  • Under age 21
  • Disabled
  • Blind
  • Pregnant
  • Skilled nursing or intermediate care home
  • On refugee status for a limited time
  • A parent or caretaker relative of an age-eligible child
  • Have been screened for breast and/or cervical cancer 

To receive coverage from Medi-Cal for addiction treatment, you have to get treatment from a Drug Medi-Cal certified program. To find one, you can contact your county and request some options.

While Medi-Cal offers coverage for mental health and addiction treatment services, many treatment centers don’t accept coverage from Medi-Cal. The same is true for many private doctors’ offices and other healthcare services centers. Federally funded insurance providers like Medi-Cal and Medicaid often offer lower payouts and more administrative paperwork that make it difficult or undesirable for many treatment centers and doctors’ offices to accept coverage. To handle the workload required to process federally funded insurance, private healthcare providers often need to hire additional staff. 

However, while your options may be more limited than someone with private health insurance, you still have options for addiction treatment with Medi-Cal. Some private treatment centers do accept Medi-Cal coverage, and there are also publicly funded options to help connect you to treatment services.

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