Medicaid is a state-operated health care system. It provides medical assistance for families with low incomes, children with disabilities, and pregnant women, among others.
Illinois Medicaid is administered by Healthcare and Family Services (HFS). It offers alcohol and substance use treatment to individuals who qualify.
Many people with a substance use disorder are unaware that they may be eligible to receive treatment through Medicaid.
Does Illinois Medicaid Cover Alcohol Rehab?
Eligible Illinois residents may receive covered medical benefits under the Illinois Medical Assistance Program through HealthChoice Illinois and YouthCare. Both MCO's cover substance abuse treatment, including alcohol treatment for qualified patients.
Inpatient and outpatient services are available to eligible individuals throughout the state of Illinois.
Yes. The state of Illinois provides coverage for substance use disorder treatment through the medical assistance (Medicaid) program. To receive alcohol rehab, individuals must meet certain criteria to qualify for medical assistance.
Medicaid helps by paying for some or all of an individual's addiction treatment costs. For example, it may cover outpatient care, detoxification services, and residential treatments. In order to qualify for coverage through Medicaid, individuals must meet certain criteria such as having limited income or being disabled.
Medicaid is a public medical assistance program that helps pay for healthcare costs for low-income Americans. It also helps pay for healthcare costs for people with disabilities, seniors, and low-income families. In addition, some states have expanded Medicaid under the Affordable Care Act (ACA), which means that more adults can qualify for coverage based on their income level.
Services Covered for Substance Use Disorders
Covered substance use services include outpatient treatment and residential rehab. Outpatient treatment means counseling that's less than 9 hours a week. Residential rehab is longer term treatment usually in a community-based facility.
People who are diagnosed with addiction to drugs or alcohol may receive other services, too. These can help them recover from their addiction or cope with it. Services could include:
Medication assisted recovery
Case management services
Detoxification support
Residential rehabilitation ranges in intensity based on individual need, continuing assessment, and level of care placement. The following levels are ASAM 3.1, 3.5 care.
There are several other covered services that address the full spectrum of needs associated with substance use disorders. They include:
Substance Use Disorder Case Management Services
Peer to Peer Services
HealthChoice Illinois Managed Care Plans
HealthChoice Illinois is the state's managed care health care program covering Medicaid recipients. It rolled out on January 1, 2018 to include most members of the previously mandatory managed care program.
The Illinois Client Enrollment Broker helps people get enrolled in a health plan. There are different managed care plans available throughout Illinois, each one serving a specific region of the state.
Managed care plans cover substance abuse treatment at the level of services required by each member. Substance use disorder treatment may include outpatient services, short-term residential services, and/or intensive outpatient services.
These plans must provide a comprehensive array of medical benefits, including those for mental health and substance use disorder treatment. The MCO is responsible for providing referrals to substance abuse treatment providers.
Medications Without Prior Authorization
Note: There is no prior authorization required when the medication is prescribed for alcohol dependence.
HFS removed prior authorization requirements for these medications:
naltrexone
disulfiram
acamprosate
The Heroin Crisis Act (Public Act 99-0480) also requires that HFS provide coverage for all FDA-approved forms of MAT prescribed for opioid or alcohol use disorders to Medicaid eligible participants.
Most of the time, the best treatment option for people suffering from alcohol use disorder is a combination of medications and behavioral therapy.
Prescription drugs are among benefits covered for eligible persons when prescribed by an enrolled provider.
Medication-Assisted Treatment (MAT) consists of FDA-approved medications used in combination with counseling to treat alcohol or opioid dependence.
Medicaid eligible participants may receive FDA-approved medications for substance use disorder treatment, including Alcohol Use Disorder (AUD), without the requirement of prior authorization.
Who Qualifies for Illinois Medicaid
HFS Medical Programs decide who qualifies under each program.
Adults age nineteen to sixty four who meet income guidelines can apply for medical assistance coverage through the ACA Adults Program.
ACA Adults under the Affordable Care Act can receive coverage when they meet income guidelines.
People who are eligible for Medicaid must be residents of Illinois, United States citizens or legal immigrants.
Children and pregnant women can be eligible under different programs.
Persons may also qualify based on age, disability, or pregnancy.
Some programs require a specific medical diagnosis to qualify, while others provide care for all medical problems.
If you have questions about eligibility or need more information about your program, contact HFS directly.
In some cases, coverage is limited based on program type.
In addition to rehab, eligible enrollees can get other benefits like doctor visits, hospital stays, and prescriptions drugs.
How to Apply
Illinois residents can apply for medical benefits using the Application for Benefits Eligibility (ABE) online system.
Applying for Illinois Medical Assistance requires a completed application. Applications are available at local Department of Human Services offices and other locations.
A DHS Family Community Resource Center can help you apply for all state and federal benefit programs available in your area (SNAP/Link, TANF, etc.). The centers are staffed by eligibility workers who will help you gather the information needed to determine if you qualify for any available assistance programs.
After Medicaid approval the Client Enrollment Broker will work with you to select your Managed Care Organization.
In order to get help for an alcohol use disorder (AUD) or addiction in Illinois, you may be able to access alcohol treatment through Medicaid.
Illinois Medicaid covers alcohol and drug rehab in Illinois facilities for eligible clients. HFS is the administrative agency for the Medical Assistance program (Medicaid) in Illinois. The program is funded by state and federal dollars, and it provides medical assistance to individuals with low income or disability.
Finding a Program That Accepts Medicaid
You can ask your Managed Care Plan which providers are covered by your plan. You can also search for programs in your area and then ask them if they accept Medicaid.
Enrolled providers deliver Behavioral Health services covered by your Managed Care Plan. For example, if you are enrolled in an MCO and are looking for alcohol treatment, you can visit a treatment facility who is enrolled to provide substance use disorder services.
When a Medicaid recipient seeks to access SUD treatment and rehabilitation services, the MCO will help find an appropriate provider.
You can use the SPIDER Database to search for an agency that offers the type of treatment you need. You can also contact your Managed Care Plan to find out about programs in your area.
Treatment programs are funded through many different sources, such as private insurance, Medicaid/Medicare, and federal/state funding. Many treatment programs will accept a combination of public and private health coverage for payment of services. However, even if you do not have health coverage, it is still possible to get help.
