Overview of Medicaid Coverage

Because Medicaid provides substance abuse treatment as a state option, Medicaid coverage for buprenorphine treatment varies significantly by state. Some states reimburse Medicaid patients for buprenorphine treatment, and others do not, even when it is listed on the formulary. For example, in New Jersey, the Suboxone® tablet itself was covered by Medicaid, but the office-based treatment visits were not (Colameco et al, 2005). Check with your state for the current status on reimbursement for buprenorphine.

Medicaid coverage of buprenorphine depends on:

  • Prior authorization and medical necessity
  • If your state's Medicaid plan is offered through a managed care or HMO program
  • If buprenorphine is on your state's formulary list, check online or call your state's Medicaid office to determine what coverage is available for buprenorphine treatment.

Medicaid Screening and Brief Intervention Codes

New Screening and Brief Intervention (SBI) codes are currently in place in 9 states. These codes, H0049 - Alcohol and Drug Screening, and H0050 - Brief Intervention, enable physicians to be reimbursed for screening Medicaid-eligible patients for substance abuse.

The states with the codes in place thus far are: Iowa, Maryland, Minnesota, Montana, Oklahoma, Oregon, Tennessee, Virginia, and Washington. Wisconsin provides SBI as part of a package for pregnant women.

Note for Medicaid licensed providers who live in states where Medicaid pays for buprenorphine treatment: charging cash for buprenorphine treatment is illegal and state attorney generals have been investigating such practices.



Related Resources: 
Description: 
This chapter of the TIP 45 discusses funding, resources, organization and patient contracts in substance abuse treatment.
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Description: 
This study examines decision-making in the buprenorphine treatment distribution and payment systems. The study is based on interviews with health care leaders involved in the distribution and adoption of buprenorphine.
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The Center for Substance Abuse Treatment (CSAT)
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Description: 
This is the web format of a special addiction program by HBO. The material covers issues such as who pays for addiction treatment, and drug treatment for adolescents.
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Home Box Office, Inc., 2007
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Description: 
List of contact information and websites for all of the state health departments.
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Centers for Disease Control and Prevention
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Description: 
This PDF offers information on how rural health programs can receive funding from Medicaid for certain services and treatments in order to increase patient access to health care.
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U.S. Department of Health and Human Services
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