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Public assistance programs offer financial aid for families and individuals experiencing hardship or those who meet specific eligibility requirements. Funding for these programs is provided through federal and state monies.
Public assistance programs in the United States typically vary by state and even sometimes by specific counties or municipalities. Examples of public assistance programs that provide detox and addiction treatment services include public behavioral healthcare programs run or funded by state and federal funds, such as those operated through grant programs, and Medicaid. Public addiction treatment programs offer services to eligible residents who have limited financial means and may not be able to afford treatment as well as those who do not carry health insurance.
Medicaid is the federal health insurance program that offers medical coverage for individuals who demonstrate financial need as well as other eligible individuals. Medicaid can be tailored for residents in individual states as well. In California, the Medicaid program is called Medi-Cal.
Medicaid, Medi-Cal, and public addiction treatment programs can provide detox and addiction treatment services to eligible residents.
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Addiction can be a costly disease. The National Institute on Drug Abuse (NIDA) estimates that drug, alcohol, and tobacco abuse costs society more than $600 billion each year when taking into account healthcare costs, lost workplace production, and expenses related to criminal justice and law enforcement issues brought on by substance abuse. Addiction treatment is very cost-effective and saves both individuals and society in general money in the long run. NIDA estimates savings may be as high as $12 for every $1 spent on treatment for this relapsing and chronic brain disease.
Treatment expenses can add up quickly, however, and families often need help budgeting for these services. Low-income families and individuals, with or without health insurance coverage, can often qualify for public addiction treatment and detox services. These programs typically offer priority to pregnant women, as well as those in immediate crisis and people with families.
Public detox and treatment programs are regionalized and specific to where a person has residency. For example, public treatment programs in California are managed through the California Department of Health Care Services (DHCS), which then breaks down care to serve specific regions.
For Orange County, the Behavioral Health Services (BHS) division of the Orange County Health Care Agency (HCA) oversees public addiction treatment service providers. The Coalition of Orange County Community Health Care Centers (COCCC) operates an interactive map and web-based tool to find specific providers offering public detox and treatment services in Orange County.
Behavioral healthcare services are offered directly through community-based providers, such as those listed on the interactive map hosted by COCCC. These service providers are licensed by the state and funded through federal and state funds, such as those provided through grants like the Substance Abuse and Mental Health Services Administration’s Substance Abuse Prevention and Treatment Block Grant (SABG). SABG funds addiction treatment and substance abuse prevention programs in all 50 states.
A bill signed into law by President Lyndon B. Johnson in 1965 set the stage for Medicare and Medicaid as we know it today, the Centers for Medicare and Medicaid Services (CMS) publishes. Medicare is a health insurance program that offers coverage for American citizens aged 65 and older while Medicaid is a form of public assistance offering health insurance coverage for the following:
In 2010, Medicaid was expanded via the Affordable Care Act (ACA) to cover more people and services. This now includes coverage for behavioral healthcare services and addiction treatment, Healthcare.gov explains, which must be covered to the same extent as other medical and surgical conditions.
As a form of public assistance, individuals are required to apply for Medicaid and meet eligibility requirements, which typically includes falling below a specific household income amount. Often, the federal poverty level (FPL) is used as a barometer to determine poverty and financial need.
Medicaid is also state-specific, and in California, it is run through the Medi-Cal program. Medi-Cal is funded through both the federal government and the state of California government to provide health insurance for individuals who otherwise would not be able to obtain it. Fees for Medicaid and Medi-Cal are based on what an individual and family are able to afford. Coverage is offered either for free or at a low cost based on income and other financial eligibility factors and criteria.
Just like with Medicaid, Medi-Cal considers mental health and substance abuse treatment as one of the 10 “essential health benefits” that must be covered through the ACA. This means that Medi-Cal coverage can be used to help pay for detox and addiction treatment services.
Substance abuse and mental health services covered through Medi-Cal include:
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To use Medi-Cal or Medicaid as a form of public assistance to pay for detox and/or addiction treatment services, an individual must currently have coverage through the program and be caught up on monthly premiums (if there are any). Coverage is dependent on individual policies and can differ from person to person and state to state.
In order to use Medicaid to pay for treatment services, a person may need to obtain a referral from a primary care provider (PCP) and demonstrate medical need for the services requested. Individuals may need to enter into an outpatient program first; then, if that isn’t as effective as it needs to be, coverage may be expanded to include residential, or inpatient, addiction treatment.
Medicaid-covered services are often provided through specific providers that may need to be considered “in-network,” in order for care to be covered. Services may be covered via a percentage as well. For example, detox services may be covered at 80 percent, which then means that the individual will be required to pay for the remaining 20 percent out of pocket.
Services may be capped as well. This means that a treatment program stay may be limited to 30 days, for instance, or a certain number of therapy sessions may be allowed within a calendar year. Many public assistance programs will ensure that required services are either completely covered or covered on a sliding scale, depending on what a person may be able to afford to pay.
Public detox and addiction treatment programs, as well as providers that accept Medicaid for payment, often fill up rather quickly as they typically have a certain number of beds allotted for public assistance programs and patients. As mentioned, priority is given to specific populations, such as pregnant women, and there may be long waiting lists to get in.
The Behavioral Health Treatment Services Locator can help individuals find treatment providers that accept Medicaid as a form of payment for addiction treatment services. Even providers that may not use public assistance programs for services often have financing and payment options that are flexible and can work within a family’s budget. Knowledgeable staff members at treatment facilities can help families and individuals navigate insurance and public assistance programs, and decide how to finance detox and addiction treatment services.