Rehab Centers that Accept MassHealth Insurance

MassHealth is the state Medicaid program in Massachusetts and includes the Children’s Health Insurance Program (CHIP) and adult Medicaid coverage. As of 2023, the BlueCross Massachusetts Foundation reported that 2.36 million people had coverage under MassHealth programs.

Like most major insurance plans, MassHealth offers behavioral health benefits, including coverage for addiction treatment. However, the amount of rehab coverage depends on your plan, provider network status and prior authorization requirements. Because rehabs may be in- or out-of-network, it’s important to understand your benefits as you seek addiction treatment.

MassHealth covers addiction treatment. It must comply with both state and federal parity laws, and Massachusetts’ requirements are even stronger than federal ones. Parity laws require health insurance companies to provide the same level of coverage for behavioral health treatment as they do for physical health treatment.

Generally, MassHealth follows a managed care model, which involves contracts with in-network providers. Prior authorization, which requires your insurance plan to preapprove services as a condition for potential claim payment, is common across MassHealth’s managed care plans. The authorization and network reliance mean the rehab you choose can impact whether your plan covers treatment and to what degree.

According to the Massachusetts Executive Office of Health and Human Services, MassHealth benefits cover a full continuum of care for substance use disorders.

That includes:

• Residential/inpatient addiction treatment
• Outpatient treatment
• Specialty treatment

Some MassHealth plans require treatment locations to enroll as managed care providers, but referrals from MDs or prior authorization aren’t always required for covered treatment.

MassHealth continuum of care documents note that both 24-hour and non-24-hour care treatment options are covered for addiction treatment.

Medical Detox

MassHealth calls this level of care “medically monitored intensive inpatient treatment” or acute treatment services (ATS). It documents an average of 6 to 7 days of treatment at this level of care, though it’s not a specific guideline for how long it will pay for medical detox.

Inpatient or Residential Rehab

MassHealth inpatient rehab coverage includes a variety of care needs for different populations. What it calls Residential Rehabilitation Services (RRS) covers treatment for co-occurring mental health conditions and substance use disorder and has an average length of stay of 90 days. MassHealth notes that treatment length varies by program and individual need.

Medication-Assisted Treatment (MAT)

Coverage for MAT programs depends on benefits and the exact substance use diagnosis. MassHealth specifically calls out opioid treatment services as covered via FDA-approved treatments at outpatient treatment centers.

Therapy and Counseling

MassHealth provides benefits for up to 20 hours per week in intensive outpatient programs (IOPs), which it calls Structured Outpatient Addiction Programs (SOAP). Standard outpatient treatment, which includes evidence-based counseling and therapy approaches, may also be covered.

Dual-Diagnosis Support

Yes, MassHealth continuum of care documents specifically address co-occurring diagnoses, although coverage specifics depend on your plan and treatment needs. The company typically covers treatment for mental health conditions, such as anxiety, depression and post-traumatic stress disorder.

Aftercare and Continuing Support

Aftercare refers to step-down services that support you as you leave inpatient treatment programs or intensive outpatient options. Therapy, medication management and other clinical services may be covered.

Understanding network requirements can help you avoid surprise bills and plan financially for getting addiction treatment. Many of MassHealth’s plans operate through managed care networks, meaning the insurance company contracts with approved providers. These providers are considered in-network; other providers are considered out-of-network.

In-network providers usually agree to negotiated rates. In return, the insurance company passes less of the cost percentage on to you, which can result in a lower out-of-pocket cost.

Out-of-network providers don’t have these agreements. MassHealth may not approve services with an out-of-network provider or may not cover services as fully as it would with an in-network provider.

Sometimes, services you receive during a treatment program are offered by outside providers. An insurance verification can help you determine whether a rehab facility or another provider is in-network with your plan.

Because MassHealth is a state Medicaid program, out-of-pocket costs for covered services are very limited. This means you usually won’t pay a co-pay or deductible if MassHealth covers a service.

If you want uncovered services, which are services MassHealth doesn’t pay for at all, you typically need to make financial arrangements for those.

MassHealth provides numerous coverage types designed to help individuals and families access physical and mental health services, including treatment for substance use disorder.

Plans that include mental health and addiction services include:

• MassHealth Standard
• MassHealth CommonHealth
• MassHealth CarePlus
• MassHealth Family Assistance
• Premium Assistance

An insurance verification provides you with up-to-date, accurate information about your benefits. It can help you determine whether MassHealth may cover addiction treatment at a specific rehab center.

DIY Verification Steps

You can call the customer service number on your MassHealth benefits card or paperwork. When talking to your insurance provider, ask whether addiction treatment with a specific provider is covered. You may also want to ask:

• What specific services are covered, such as MAT, therapy or prescription medications
• Whether there’s a cap on treatment length or the number of services
• Whether you may pay out-of-pocket costs related to a deductible or co-pay (generally not common with MassHealth-covered services)

You can also check some of this information in your member portal online.

Fastest Option: Let a Rehab Verify for You

Usually, the easiest way to verify whether your MassHealth benefits will cover a specific service is to let the rehab center handle verification for you. A provider can typically verify your benefits immediately and help you understand what’s covered.

A common reason for a MassHealth program to say services won’t be covered is that they think you have another insurance policy. As a Medicaid payer, MassHealth is considered a “payer of last resort,” meaning it only covers claim costs after other relevant health insurers have paid. If you don’t have other insurance coverage, ensure MassHealth has your correct information on file.

If other coverage isn’t the issue and MassHealth still won’t cover your services, you can appeal the decision within 30 days. You might also consider whether the company would cover your services if you chose another rehab if your first choice doesn’t accept MassHealth or isn’t in-network with your plan

Help.org offers free access to lists of rehab programs, including those that may accept MassHealth insurance. If you want to use your MassHealth rehab coverage to get help for alcohol or drug addiction, you can browse rehabs by location, type of services and other details.