residential specialty treatment settings or
inpatient care for patients ages 22- to 64-
years old in institutions for mental
disease;^136 and Outpatient hospital care,* including
detoxification, individual, group or family
counseling and/or psychotherapy, and
diagnosis, treatment, assessment and
medication management.^137
Optional benefit categories under which
addiction-related treatment services also may be
provided include:
Outpatient rehabilitation services, including
diagnostic and treatment services. States
providing optional benefits under Medicaid
often choose this option since it does not
require services to be provided under the
direction of a physician and instead permits
the delivery of services including mutual
support by community paraprofessionals and
peers;^138
Clinic services;^139 and
Case management services.^140
Last, states may provide addiction treatment
services as part of a Medicaid managed care
waiver program.† 141
Because state Medicaid plans vary widely in
their eligibility requirements and benefits,
individuals have substantially different access to
care depending on the state in which they live.^
Some states cover a broad range of addiction-
related services; others provide only a few and
two states cover no such services.^142
State Medicaid programs also distinguish
between services offered for addiction treatment
- Several states specifically exclude addiction
treatment from the outpatient services benefits and
some place limits on the services such as number of
visits per year.
† A 2006 survey found that 31 states offer addiction
treatment through a managed care waiver program.
involving nicotine and treatment involving
alcohol and other drugs.With regard to smoking, Medicaid plans are
required to provide tobacco cessation counseling
and pharmaceutical treatments to pregnant
women, children and adolescents. States are
free to choose whether or not to include tobacco
cessation benefits for other enrollees.^143 In
2009, 18 states covered individual counseling
for all Medicaid enrollees, seven states covered
counseling only for enrollees in some programs
(fee-for-service or managed care) and six states
covered it only for pregnant women. Eight
states covered group counseling for all Medicaid
enrollees, five covered group counseling only
for enrollees in some programs (fee for service
or managed care) and five states covered group
counseling for pregnant women only. As of
2009, 34 states covered the nicotine patch for all
Medicaid enrollees, 33 covered bupropion, 32
covered nicotine gum, 32 covered varenicline,
28 covered nicotine nasal spray, 27 covered
nicotine inhalers and 25 covered nicotine
lozenges.^144 As of 2011, six state Medicaid
programs provide comprehensive coverage for
smoking cessation treatments for all Medicaid
enrollees,^ while five state Medicaid programs
provide no coverage for cessation treatment for
any enrollees.^145Medicare. Medicare is a federally-funded
system for financing health care for U.S. citizens
ages 65 and older and people under age 65 with
certain disabilities.^146 Medicare covers the
following services, when medically necessary: Inpatient hospital services for detoxification
for addiction involving alcohol and
outpatient services for detoxification for
addiction involving drugs other than
nicotine;^147 Inpatient rehabilitation treatment for
addiction involving alcohol, controlled
prescription drugs and illicit drugs in an
acute care or psychiatric hospital;^148 Outpatient hospital-based diagnostic and
therapeutic services for treatment of