Does MassHealth Cover Rehab?

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.

What is MassHealth?

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

MassHealth Coverage Types

As a MassHealth member, you can get one of six coverage types:¹

• Standard
• CommonHealth
• CarePlus
• Family Assistance
• Premium Assistance
• Limited

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

• Inpatient drug rehab
• Outpatient rehab
• Inpatient mental health treatment
• Outpatient mental health treatment
• Well-child screenings (addiction and mental health)
• Inpatient hospital services
• Doctor visits
• Pharmacy services
• Medication

MassHealth Plans

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

• MassHealth Network
• Primary Care Clinician (PPC) Plan
• Steward Health Choice
• Community Care Cooperative (C3)
• Accountable Care Organizations (ACO)
• Managed Care Organizations (MCO)
• Mass General Brigham ACO
• Senior Care Options (SCO)
• Program of All-Inclusive Care for the Elderly (PACE)

However, you may not need to enroll in a plan if you:²

• Are 65 or older
• Live in a nursing home or an assisted living facility
• Have another health plan—such as through your job or Medicare

Does MassHealth Cover Substance Use Disorder Treatment?

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

Eligibility

You may be eligible to access MBHP if you are on one of the following plans:

• Primary Care Clinician
• Community Care Cooperative
• Partners HealthCare Choice
• Steward Health Choice
• BeHealthy Partnership

MBHP services are also open to children who are:

• In the custody or care of the Department of Youth Services
• In the custody or care of the Department of Children and Families
• Members of MassHealth and have primary commercial insurance

Covered Services

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:

Emergency Services

Mobile Crisis Intervention (MCI) and Emergency Services Program (ESP) Encounter services are available 24/7/365 to anyone going through a mental health crisis.

Inpatient Services

These include mental health services, observation/holding beds, and level IV detoxification in a 24-hour hospital setting.

Diversionary Services

These can provide you with intensive support when you return to the community after your hospital stay. Examples include:

• Community Support Programs (CSP)
• Psychiatric Day Treatment
• Acute Treatment Services (ATS) for Substance Use Disorders
• Enhanced Acute Treatment Services (E-ATS) for Individuals with Co-Occurring Mental Health and Substance Use Disorders
• Clinical Stabilization Services (CSS) for Substance Use Disorders

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:

• Ambulatory Detoxification
• Structured Outpatient Addiction Program (SOAP)

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.

How Much Does Treatment Cost with MassHealth?

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.

How Much Does MassHealth Cost?

As a MassHealth member, you may need to pay copays and/or monthly premiums.^4,5

Copays

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

• Drugs for substance use disorders such as Vivitrol or Suboxone
• Family planning drugs
• Certain preventive drugs
• Drugs to help you quit smoking

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

• $1 for certain generic and over-the-counter medications for diabetes, high cholesterol, and high blood pressure, such as metformin, lisinopril, and simvastatin
• $3.65 for all other covered drugs

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

• Under 21 years old
• A former foster care child
• Pregnant or have recently given birth
• American Indian or an Alaska Native
• In a long-term care facility
• Receiving hospice services
• Receiving certain public assistance benefits or benefits under MassHealth Limited
• A member who has MassHealth Standard or Senior Buy-In and are receiving a drug under Medicare Parts A and B only
• In another exempt category

Premiums

MassHealth will tell you if you need to pay a monthly premium. You may need to pay a premium if:⁵

• Your income is more than 150% of the FPL; or
• Your income is at or above 200% of the FPL, and you are a member of the Children’s Medical Security Plan (CMSP); and
• You are receiving Standard, CommonHealth, or Family Assistance coverage

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).

How to Qualify for MassHealth

The basic requirements for MassHealth coverage are:⁶

• Residency: You must reside or intend to reside in Massachusetts, or have entered the state to seek employment or with a job commitment
• Immigration status: For maximum coverage, MassHealth will need to verify your citizenship or satisfactory immigration status with relevant state and federal agencies
• Financial: You must meet certain financial requirements

Eligibility for Different Coverage Types

MassHealth has different eligibility requirements and coverage types if you are:

• Younger than 19 years of age
• Aged 19 or 20
• Aged 21 through 64
• Aged 65 and older
• In need of long-term care services
• Pregnant
• Disabled
• HIV-positive
• A breast or cervical cancer patient
• A parent living with your children under 19
• An adult caretaker living with children under 19

How to Apply

To apply for MassHealth coverage, fill out and submit:

• Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3); or
• Application for Health Coverage for Seniors and People Needing Long-Term-Care Services

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.

How to Find Rehab Centers in M.A. That Accept MassHealth

At Boston Drug Treatment Centers, we specialize in helping people find the best treatment center for their needs. Call us at (857) 577-8193 to speak to one of our treatment support specialists and discover rehabs that accept MassHealth.

Frequently Asked Questions About MassHealth

Is MassHealth Free?

Some MassHealth members may need to pay copays and/or monthly premiums, but others may be eligible for waivers.

What Does MassHealth Pay For?

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.

What Does MassHealth CommonHealth Cover?

MassHealth CommonHealth provides benefits to certain disabled adults and children who do not qualify for MassHealth Standard. Covered services include:⁹

• Medical, inpatient, and outpatient services
• Mental health and addiction services
• Adult day health and foster care
• Well-child screenings for children under 21
• Long-term support at home or in a long-term care facility
• Services to help you quit smoking
• Transportation

Does MassHealth Cover Drug and Alcohol Addiction Treatment?

Yes, MassHealth covers addiction treatment programs for drugs and alcohol, on both an inpatient and outpatient basis.

Does MassHealth Cover Inpatient Rehab?

Depending on your coverage type and health plan, MassHealth rehab coverage may include inpatient services.

How Can You Check Your MassHealth Application Status?

To check the progress of your application, call the MassHealth Enrollment Centers at (800) 841-2900 (phone) or (800) 497-4648 (TTY).

Resources

 

1. Mass.gov. (2021, August). MassHealth Coverage Types for Individuals and Families Including People with Disabilities.
2. MassHealth.ehs.state.ma.us. (2021, August). Welcome to the Provider Directory!
3. MassPartnership.com. (2021, August). Covered Services.
4. Mass.gov. (2021, August). MassHealth Copay Information—for Members.
5. Mass.gov. (2021, August). MassHealth Premium Information—for Members.
6. Mass.gov. (2021, August). Eligibility for Healthcare Benefits for MassHealth, the Health Safety Net, and Children’s Medical Security Plan.
7. Mass.gov. (2021, August). Apply for MassHealth, the Health Safety Net, or the Children’s Medical Security Plan.
8. Mass.gov. (2021, August). Apply for MassHealth Coverage for Seniors and People of Any Age Who Need Long-Term-Care Services.
9. Mass.gov. (2021, August). MassHealth CommonHealth.