What Is MassHealth and Does It Cover Drug and Alcohol Treatment?

Who is eligible for MassHealth, and does the program cover treatment for addictions to alcohol and other drugs?

What Is MassHealth?

MassHealth is the name of the government organization in Massachusetts that administers two types of public health insurance:

• Medicaid – This program provides coverage for low-income people, including families and children, pregnant women, seniors, and individuals with disabilities
• Children’s Health Insurance Program (CHIP) – CHIP offers healthcare coverage for children whose families exceed the maximum income for Medicaid, but who cannot afford to purchase private insurance.

Medicaid and CHIP are both jointly funded by the states and the federal government, but they are administered by each state. Some states have separate names for each program, but in Massachusetts, Medicaid and CHIP are combined into MassHealth.

Types of plans

The MassHealth umbrella includes several of plans, including:

• MassHealth Standard – Full range of healthcare benefits
• MassHealth CommonHealth – For disabled adults and disabled children who aren’t eligible for MassHealth Standard
• MassHealth CarePlus – For adults who don’t qualify for MassHealth Standard 
• MassHealth Family Assistance – For state residents who are not eligible for MassHealth Standard
• MassHealth Limited – Emergency services for people whose immigration status prevents them from accessing other plans
• MassHealth Premium Assistance – For MassHealth members who have access to private health insurance through their job or family
• MassHealth Medicare Savings Program – Assistance with Medicare costs for individuals who are at or below 225% of the federal poverty line

The scope of programs and services that MassHealth will pay for can vary depending on which plan a person is enrolled in. 

Eligibility

Generally speaking, to be eligible for MassHealth coverage you must meet two criteria:

• You must be a resident of Massachusetts.
• Your modified adjusted gross income (MAGI) must be below a certain level.

There’s no single MAGI cutoff level that applies to every person. The maximum allowable MAGI can vary depending on factors such as:

• Your age
• Your family size
• If you are pregnant
• If you are disabled
• If you are in a long-term care facility

The Massachusetts Health Connector can help you determine if you are eligible for MassHealth. 

Does MassHealth Cover Alcohol Treatment?

Many MassHealth plans – including Standard, CommonHealth, Family Assistance, and CarePlus – cover treatment for substance use disorders, which is the clinical term for addiction. This includes alcohol use disorder (alcoholism).

Other covered addictions

Other types of addictions that most MassHealth plans cover include:

• Cannabis use disorder (marijuana addiction)
• Opioid use disorder (such as addictions to heroin, fentanyl, and many prescription painkillers) 
• Stimulant use disorder (a category that includes cocaine, amphetamine, and methamphetamine)
• Sedative, hypnotic, or anxiolytic use disorder (which covers benzodiazepines, barbiturates, and similar substances)
• Hallucinogen use disorder (LSD, ketamine, psilocybin, DMT, and other psychedelics)

This is by no means a comprehensive list of all addiction types covered by MassHealth plans. If you are a MassHealth member whose life has been disrupted by any type of compulsive substance use, Lake Avenue Recovery Center can help you determine if your plan will pay for your treatment.

Mental health coverage

MassHealth plans that cover drug and alcohol treatment also cover mental healthcare. This is a vital feature, because many people who struggle with alcoholism and other addictions have also been affected by anxiety, depression, bipolar disorder, PTSD, and other co-occurring mental health concerns. 

Clinicians use the term “dual diagnosis” to describe having an addiction and a mental health concern at the same time. If you have dual diagnosis, it’s important that your treatment addresses the full scope of your needs. If you are covered by MassHealth, you should be able to receive the comprehensive care you need. 

Note: You do not need to be addicted to alcohol or another drug for your mental health services to be covered under MassHealth. If you plan includes mental health coverage, that benefit is not contingent on you also receiving help for an addiction.

What Types of Services Does MassHealth Cover?

The regulations that govern MassHealth are found in Title 130 of the Code of Massachusetts Regulation, which is commonly referred to as 130 CMR. 

According to Chapter 418 of that section (130 CMR 418.000), substance abuse treatment services that may be covered by MassHealth include:

• Withdrawal management (detox)
• Acupuncture withdrawal management
• Medication-assisted treatment (MAT)
• Inpatient treatment
• Clinical stabilization services
• Residential rehab
• Transitional support services
• Outpatient treatment
• Peer recovery coaches
• Recovery support navigators
• Outpatient counseling

If you’re not certain whether or not the type of care you need is covered by your MassHealth plan, the center where you intend to receive treatment should be able to help. At Lake Avenue Recovery Center, we can help you understand your MassHealth benefits and ensure that you know exactly what programs and services it covers. 

Learn More About Using MassHealth to Cover Addiction Treatment in Worcester

Lake Avenue Recovery provides personalized outpatient care for adults who have become dependent on alcohol and other drugs. We also serve clients who have anxiety, depression, PTSD, and other co-occurring mental health concerns.

Treatment options at our center in Worcester, MA, include:

• High-intensity outpatient treatment (9 a.m. – 3 p.m., five days per week)
• Intensive outpatient program (9:00 a.m. – 12:30 p.m., up to four days per week)
• Evening IOP (5:30 p.m. – 9 p.m., up to four days per week)

A member of our team will be happy to discuss the features and benefits of  each option with you, so that you can make the most informed decisions about your care. We can also answer any questions that you have about using MassHealth or private insurance to pay for your treatment.

To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Admissions page or call us today.