MassHealth is the Massachusetts branch of Medicaid and the Children’s Health Insurance Program (CHIP). The program covers various healthcare benefits, including behavioral health, drug rehab, alcoholism treatment, and substance use disorder services.
If you live in Massachusetts, you can access Medicaid and CHIP through a single program: MassHealth.
Membership is open to eligible low and medium-income individuals and families, as well as people with disabilities, seniors, and people who need long-term care.1
As a MassHealth member, you can get one of six coverage types:1
Your coverage will depend on factors such as your immigration status, income, age, and other personal circumstances. Depending on your coverage type, you may receive healthcare benefits directly or have MassHealth pay your health insurance premiums in whole or in part.
Depending on which MassHealth coverage type you have, the following addiction services may be covered:1
Some MassHealth members must enroll in a health plan. A health plan is a group of hospitals, healthcare providers, and other professionals that work together.
MassHealth plans include:2
However, you may not need to enroll in a plan if you:2
MassHealth members can access substance use disorder services through the Massachusetts Behavioral Health Partnership (MBHP), a network of 1,200+ behavioral healthcare providers that cater to more than 500,000 patients statewide.3
You may be eligible to access MBHP if you are on one of the following plans:
MBHP services are also open to children who are:
MBHP offers integrated medical and behavioral health services and varying levels of care. This way, you can receive a personalized treatment plan that meets your unique needs. Covered services include:
Mobile Crisis Intervention (MCI) and Emergency Services Program (ESP) Encounter services are available 24/7/365 to anyone going through a mental health crisis.
These include mental health services, observation/holding beds, and level IV detoxification in a 24-hour hospital setting.
These can provide you with intensive support when you return to the community after your hospital stay. Examples include:
Outpatient Mental Health Services
These include individual, group, and family/couples therapy and help with various mental health issues like depression, anxiety, PTSD, adjustment disorders, and more. You can access such services in hospital outpatient departments, community health centers, your home, school, and elsewhere in the community.
Outpatient Substance Use Disorder Services
These can support you during your withdrawal and recovery process and include services such as:
Integrated Care Management Program (ICMP)
ICMP is open to PCC plan members with more than one medical, mental health, or substance use disorder. The program can help you learn more about your conditions and how to care for your health.
If your MassHealth membership is in good standing, and you go to an in-network provider, there is no copay for any type of behavioral or substance use disorder care (a copay is a small sum that you may need to pay when receiving health services). However, you would still need to pay your monthly premium, if any, per your coverage type.
MassHealth does not have copays for any covered services. The only exception is when you get certain prescription drugs. However, this does not apply to:4
For all other medications, whether first-time prescriptions or refills, the total copay amount for a 90-day supply of a covered drug is:4
Furthermore, MassHealth has a copay cap and cannot bill you more than 2% of your monthly household income in a given month.
Finally, you may not have to pay a copay at all if your income is at 50% of the federal poverty level (FPL) or lower or you are:4
MassHealth will tell you if you need to pay a monthly premium. You may need to pay a premium if:5
The amount will depend on your income, family size, personal circumstances, and other health insurance but cannot be more than 3% of your monthly household income (this does not apply to people with CommonHealth coverage).
The basic requirements for MassHealth coverage are:6
MassHealth has different eligibility requirements and coverage types if you are:
To apply for MassHealth coverage, fill out and submit:
If you need help completing the form, contact the MassHealth Customer Service Center or visit your local MassHealth Enrollment Center.
MassHealth will then carry out a MassHealth eligibility check to determine the most comprehensive coverage type or program for you.
At Boston Drug Treatment Centers, we specialize in helping people find the best treatment center for their needs. Call us at 617-517-6448 to speak to one of our treatment support specialists and discover rehabs that accept MassHealth.
Some MassHealth members may need to pay copays and/or monthly premiums, but others may be eligible for waivers.
MassHealth pays for various coverage types and services, such as drug and alcohol rehab, detox services, mental health services, doctor visits, hospital stays, prescription drugs, and medical equipment.
MassHealth CommonHealth provides benefits to certain disabled adults and children who do not qualify for MassHealth Standard. Covered services include:9
Yes, MassHealth covers addiction treatment programs for drugs and alcohol, on both an inpatient and outpatient basis.
Depending on your coverage type and health plan, MassHealth rehab coverage may include inpatient services.