Does Medicaid Cover Rehab in Texas?

Texas Medicaid covers some forms of addiction treatment and drug rehab, depending on the service, setting, and level of care.

Addiction treatment can be very expensive, but it’s quite possible to get the care you need at a reasonable cost. The key is to do your research and ask the necessary questions to find the best, most affordable care.

If you or a loved one has state aid, there are several Texas rehabs that accept Medicaid. However, it’s essential to fully inform yourself on what Texas Medicaid is, what’s covered, and whether you’re eligible.

What is Texas Medicaid?

Texas Medicaid is a state health insurance program that is jointly funded by the federal government and the state of Texas.

Medicaid provides health coverage to millions of Americans, including eligible adults and children, as well as:¹

• Elderly individuals
• Pregnant people
• People with disabilities who qualify as low-income

Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Its mission is to improve Texans’ health, safety, and well-being through its hundreds of available programs and services.²

Medicaid is one of the largest public health insurance programs in the United States. It covers more than 75 million Americans, including over 1 million people in Texas.^3,4

Does Texas Medicaid Cover Substance Abuse Treatment?

Texas Medicaid does cover screening and treatment services for substance use disorders (SUD).⁵

Currently, Texas rehab programs and services covered by Medicaid include:⁵

• Assessment
• Outpatient treatment
• Medication-assisted therapy (MAT)
• Residential/outpatient detoxification

A few additional services are also available to women who qualify for the Healthy Texas Women Plus program and need additional postpartum care. These services included:⁵

• Screenings, brief interventions, and referrals to treatment for SUD
• Outpatient substance use counseling
• Medication-assisted treatment (MAT)

Understanding the Levels of Care

The levels of care used by the Texas Health and Human Services are broken down according to the American Society of Addiction Medicine (ASAM). These levels of care were first defined in the 1980s to provide one national set of criteria for the care and treatment of addiction.⁶

Care is broken down into four primary levels:^6,7

• Level 1 – Outpatient Services: Less than 9 hours/week (adults); less than 6 hours/week (adolescents) for recovery or motivational enhancement therapies/strategies
• Level 2 – Intensive Outpatient Services: 9+ hours of treatment/week (adults); 6+ hours/week (adolescents) to treat multidimensional problems
• Level 3 – Residential Inpatient Services: 24-hour care by trained professionals in a facility that more so resembles a home environment; may also be called a therapeutic community
• Level 4 – Intensive Inpatient Services: 24-hour nursing and doctor care in a hospital environment. Counseling is also offered to help you deal with your drug or alcohol abuse

How Much Does Treatment Cost with Texas Medicaid?

The cost of Dallas addiction treatment varies depending on the type of care, the setting in which your treatment occurs, and which services are used.

As Medicaid is a low to no-cost program, approved treatments for substance use disorders are often covered at no cost to you.^9,10

How Much Does Texas Medicaid Cost?

If you’re found eligible for Texas Medicaid, then chances are you won’t have any out-of-pocket expenses or premium payments.

However, if you are eligible for a Medicaid Buy-In program, your cost will be determined based on your income.^11,12

How to Qualify for Texas Medicaid

The Texas Medicaid program offers a comprehensive range of health care services for low-income Texans. To qualify for Texas Medicaid, you must meet one of the following requirements:

• Be pregnant
• Be responsible for 1 or more children 18 years of age or younger
• Be found legally blind
• Have a medically diagnosed disability or have a family member in your household with a medically diagnosed disability
• Be 65 years of age or older

You must meet the income limits listed below (before taxes):

• Household Members – 1; Maximum Income Level (Per Year): $25,503
• Household Members – 2; Maximum Income Level (Per Year): $34,492
• Household Members – 3; Maximum Income Level (Per Year): $43,481
• Household Members – 4; Maximum Income Level (Per Year): $52,470
• Household Members – 5; Maximum Income Level (Per Year): $61,460
• Household Members – 6; Maximum Income Level (Per Year): $70,449
• Household Members – 7; Maximum Income Level (Per Year): $79,438
• Household Members – 8; Maximum Income Level (Per Year): $88,427

How to Apply

If you’re interested in applying for Medicaid in Texas, there are several ways you can go about it, including:

• Over the phone by calling 2-1-1 (TTY 711) toll-free Monday through Friday from 8:00 a.m. to 6:00 p.m. Central Time.₁₄
• Online at Your Texas Benefits – yourtexasbenefits.com/Learn/Home
• By fax or mail₁₅
• In person by visiting your local Texas Health and Human Services Commission (HHSC) office

During the application process, you will need to provide:

• Proof of your identity, such as your Social Security number
• Proof of citizenship or your immigration status, such as your passport, birth certificate, or Certificate of Naturalization
• Proof of income
• Proof of your expenses

If you’re applying by phone, you should still have easy access to each of the above-mentioned pieces of information. When you call, you’ll be asked to choose your preferred language. From there, a Texas Health and Human Services Commission representative will help start your application for you over the phone, walking you through each step to ensure that it’s filled out correctly. Once completed, they will send you the document in the mail to sign and send back. You will also be asked to send your proof of identity, income, expenses, and citizenship.

When applying online, you’ll be able to fill out the questionnaire at your own pace, and you will also be able to upload all necessary documentation and proof of identity.

Find a Texas Rehab Near You

Finding and choosing a Texas rehab program shouldn’t be a challenging process, which is why we are here to help. Give our 24/7, confidential helpline a call at (214) 935-2287 to speak to a treatment support specialist. They will help you find a Dallas drug rehab that accepts your insurance.

Resources

1. gov. (2015, October 2). What is the difference between Medicare and Medicaid?
2. Texas Health and Human Services. (n.d.). Vision & Mission.
3. gov. (n.d.). Medicaid.
4. Texas Health and Human Services. (n.d.). Texas Medicaid and CHIP Monthly Full Benefit Caseload By Risk Group.
5. Texas Health and Human Services Commission. (2020, December). Texas Medicaid and CHIP Reference Guide Thirteenth Edition.
6. American Society of Addiction Medicine. (n.d.). About the ASAM Criteria.
7. Texas Health and Human Services. (2020, November). Study on Substance Abuse Treatment Services.
8. Medicaid. (n.d.). Substance use disorders.
9. UnitedHealthcare Connected® MEMBER HANDBOOK. (2021). Chapter 4: Benefits Chart.
10. 2021 ABH STAR Handbook. (2021). STAR Covered Benefits.
11. Texas Health and Human Services. (n.d.). Medicaid buy-in for children.
12. Texas Health and Human Services. (n.d.). Medicaid buy-in for adults.
13. Welcome to Benefits.gov | Benefits.gov. (n.d.). Texas Medicaid.
14. Community Health Choice. (2021, August 18). How to apply Texas Star.
15. Your Texas Benefits. (n.d.). Get a Paper Form.
16. Your Texas Benefits. (n.d.). How Do I Upload Files?
17. Texas Health and Human Services. (2021, March).  Form to apply for Food Benefits (SNAP), Healthcare (Medicaid and CHIP), or cash help for families (TANF) (H1010).