Medi-Cal Coverage for Substance Abuse Treatment

Medi-Cal provides comprehensive coverage for substance abuse treatment in California. Understanding your benefits helps access the care you need without financial barriers.

What's Covered

Services Included

Medi-Cal covers comprehensive treatment:

• Outpatient services (individual and group therapy)
• Intensive outpatient programs (IOP)
• Residential treatment
• Medical detoxification
• Medication-assisted treatment (MAT)
• Case management
• Recovery support services

No Copayments

Financial accessibility:

• No copayments for substance use disorder services under Medi-Cal
• No deductibles for SUD treatment
• Reduces barriers to care
• Treatment accessible to all members

Residential Treatment

Inpatient coverage includes:

• Residential treatment: up to 90 days for adults
• Extensions possible based on medical necessity
• Short-term residential
• Recovery residences
• Ongoing assessment for continued need

Medication-Assisted Treatment

MAT coverage includes:

• Covered medications: buprenorphine, methadone, naltrexone
• All FDA-approved addiction medications
• Counseling combined with medication
• Medical monitoring
• Ongoing support services

Eligibility & Access Process

Who Qualifies

Medi-Cal eligibility includes:

• Low-income California residents
• Some individuals regardless of immigration status
• Various categories (aged, blind, disabled, families)
• Income-based eligibility
• Automatic enrollment for some benefits

Five Steps to Access Services

Step 1: Locate Providers

• Contact county behavioral health
• Use DHCS provider directories
• Call Medi-Cal member services
• Ask about in-network facilities

Step 2: Complete Assessments

• Initial screening
• Comprehensive evaluation
• ASAM Criteria assessment
• Treatment level determination

Step 3: Navigate Authorizations

• Prior authorization may be required
• Provider typically handles
• Medical necessity documentation
• Treatment plan approval

Step 4: Understand Coverage Variations

• Services may vary by county
• Managed care vs. fee-for-service
• County-organized vs. state-organized
• Know your plan type

Step 5: Seek Advocacy if Needed

• Appeal denials
• Request fair hearings
• Contact ombudsman programs
• Legal aid resources available

Assessment Framework

ASAM Criteria

Treatment matching uses:

• Providers use ASAM Criteria for holistic, person-centered treatment plans
• Six-dimension assessment
• Appropriate level of care placement
• Ongoing reassessment
• Patient-centered approach

Assessment Dimensions

Evaluation considers:

• Acute intoxication/withdrawal potential
• Biomedical conditions
• Emotional/behavioral conditions
• Readiness to change
• Relapse/continued use potential
• Recovery environment

Types of Covered Services

Outpatient Services

Community-based care:

• Individual therapy
• Group counseling
• Education services
• Case management
• Recovery support

Intensive Outpatient (IOP)

More structured outpatient:

• Multiple weekly sessions
• Group and individual therapy
• Minimum hours per week
• Step-down from residential

Residential Treatment

24-hour care including:

• Medically supervised care
• Therapeutic community
• Structured programming
• Safe environment
• Aftercare planning

Detoxification

Medical withdrawal management:

• Medically supervised detox
• Symptom management
• Medication when needed
• Transition to treatment
• 24/7 monitoring

Getting Started

Contact Your County

Each county provides services:

• County behavioral health department
• Drug Medi-Cal programs
• Substance Use Disorder services
• Referral and assessment

Questions to Ask

When calling:

• What services are available?
• How do I access treatment?
• What is the assessment process?
• Which facilities are covered?
• What documentation do I need?

Final Thoughts

Medi-Cal provides comprehensive substance abuse coverage with no copayments, making treatment accessible to California residents. Understanding covered services and the access process helps you get the care you need.

Amity Behavioral Health accepts Medi-Cal and can help navigate coverage. Contact us for assistance accessing treatment.