Medicaid Coverage for Addiction Treatment in Las Vegas Nevada

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If you or a loved one is a low-income individual struggling with addiction in Las Vegas, Nevada, you may be able to use Medicaid to help pay for rehab. Medicaid is a state-run health insurance program designed to help eligible low-income children and adults, elderly adults, pregnant women, and those with disabilities get affordable, quality health coverage.1 Medicaid is one of the largest health insurance providers in America.1 Nevada Medicaid alone provided coverage to 790,368 people in 2021.2 Understanding your Medicaid benefits and how to use them at Nevada rehab facilities can be an important step in finding recovery.

Does Medicaid Cover Rehab in Nevada?

Under the Affordable Care Act (ACA) all health insurance plans, including Medicaid, are required to provide some type of coverage for the treatment of mental and behavioral health disorders.4 In brief, treatment for mental and behavioral health disorders, like substance abuse, are considered essential benefits.5 As a result, Medicaid may be able to cover some or all of the cost of addiction rehab.

It’s important to remember that coverage can vary depending on a variety of factors. Your location, the intensity of the treatment, the length of treatment, and whether the treatment is deemed medically necessary by a health professional can all affect your Medicaid coverage. Additionally, the type of health insurance plan also can play a role in determining the extent of your rehab coverage. Nevada Medicaid consists of four different types of health care plans:3

  1. Fee-for-Service (FFS).
  2. Anthem Blue Cross and Blue Shield Healthcare Solutions (ANT) Managed Care Organization (MCO).
  3. Health Plan of Nevada (HPN) (MCO).
  4. SilverSummit Healthplan (SSH) (MCO).

Though these plans vary in design, they still must adhere to the same state and federal rules. It’s best to reach out and speak to a Medicaid representative to determine the extent of your coverage.

Types of Treatment Covered by Medicaid

When it comes to treatment for addiction that may be covered by your Medicaid plan, it’s important to know that the treatment that’s recommended for you and what may be covered will vary. Despite this, it’s important to be informed about what your options may be. As such, here is a list of some common treatments for substance abuse that may be covered by Medicaid:

  • Detox: In many cases, before receiving treatment for a substance use disorder, you will have to go through medical detox. In medical detox, one is placed under medical supervision while the body rids itself of substances.3
  • Inpatient and residential treatment: Inpatient and residential rehab are programs that accommodate the patient as they reside at the rehab center and receive 24/7 care until your discharge. Inpatient care is typically shorter than residential care, lasting a few days to weeks versus a few months to a year.7
  • Outpatient care: Outpatient treatment is typically considered to be anything that doesn’t involve an overnight stay.7 Typically, if you were recommended outpatient care, you’d arrive at the facility for your appointment, receive care, and return home after.

How to Check My Medicaid Coverage

There are a handful of ways that you can check your Medicaid rehab coverage in Nevada. You can call the number on the back of your Medicaid card or verify your benefits by logging into your Medicaid portal.8 Medicaid’s member services can put you in touch with a knowledgeable staff member who can explain your coverage details to you.

In some cases, you can also call rehabs in Las Vegas Nevada and ask them to help you check your Medicaid coverage. While it’s not a guarantee that all can help, most are trained to do so. You can also check your coverage online.

Medicaid Eligibility by Income

Only certain individuals are eligible for Medicaid. Primarily, eligibility is based on income levels, which will vary by state. Here are the federal guidelines for Medicaid eligibility, which are based on federal poverty guidelines—note that these are guidelines, not requirements.9

  • $12,880 for individuals.
  • $17,420 for a family of 2.
  • $21,960 for a family of 3.
  • $26,500 for a family of 4.
  • $31,040 for a family of 5.
  • $35,580 for a family of 6.

Here are the guidelines for Medicaid eligibility in the state of Nevada, which are a bit higher than the federal guidelines:10

  • $17,131 for individuals.
  • $23,169 for a family of 2.
  • $29,207 for a family of 3.
  • $35,245 for a family of 4.
  • $41,284 for a family of 5.
  • $47,322 for a family of 6.
  • $53,360 for a family of 7.
  • $59,398 for a family of 8.

Nevada also has guidelines for families with more than eight people. For each additional person, $6,038 should be added to the guidelines.10 Please contact the Nevada Department of Health and Human Services for more information.

Finding Rehab Centers That Take Medicaid in Las Vegas and Nevada

While treatment can be costly, Medicaid can be useful in lowering your out-of-pocket costs. The difficulty can be finding a Nevada treatment center that works with Medicaid. In Nevada, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), 53 of the 66 mental health facilities in Nevada accept Medicaid.3

An important first step would be to reach out to your Medicaid representative to determine the extent of your coverage. After, it would be a good idea to contact an prospective facilities in order to determine if they accept Medicaid or not. It’s also important to reach out to a medical professional to determine your medical needs and what type of program can best serve you.

Online directories are a good way to find rehabs in Nevada that accept Medicaid. You may also consider reaching out to a substance abuse helpline. American Addiction Centers operates a 24/7 helpline that can answer any questions you may have about rehab or the payment process. AAC also operates Desert Hope, a treatment facility in Las Vegas, Nevada.

Can I use Both Medicaid and Medicare for Rehab in Nevada?

If you are over the age of 65, are disabled, or have end stage renal disease, you may be eligible for Medicare in addition to Medicaid. Unlike Medicaid, which is run by and varies depending on the states, Medicare is a federally-run program. When one is eligible for a state Medicaid program and Medicare, it is called dual eligibility.12 What dual eligibility covers can vary, as most facilities will need to accept both Medicare and Medicaid to take advantage of both plans. It’s important to coordinate with Medicare, Medicaid, and any potential rehab centers to get the most out of your health insurance.

Do Veterans Qualify for Medicaid?

Veterans may also qualify for Nevada Medicaid if they meet the eligibility requirements set by the state. Veterans may have access to other public health insurance plans; mainly the VA health care plans or TRICARE. Those who qualify for both VA insurance and Medicaid may be able to use both plans to cover some or all of the cost of rehab in Nevada, though this will usually require them to attend VA facilities.13 It’s best to reach out to your VA representative to determine if you can use Medicaid to help cover the cost of treatment.

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