Medicaid in Minnesota - also known as “Medical Assistance” - is a popular option for many people seeking treatment for Substance Use Disorder in the North Star State. However, it can be difficult to find accurate information on how to successfully bill Medicaid for addiction treatment services in Minnesota.
To make matters even more complicated, the state updates its standards from time to time, forcing programs to scramble in order to stay in compliance with Medicaid rules.
In this post, we’ll cover some of the most frequently asked questions we hear about understanding Medicaid rules in Minnesota for addiction treatment and behavioral health organizations.
Does medicaid in Minnesota cover addiction treatment services?
Yes.
Medicaid in Minnesota covers many addiction treatment services, such as residential treatment, outpatient treatment, PHP and hospital-based treatment, residential withdrawal management, recovery peer support services, Medication Assisted Treatment or MAT, treatment coordination and SUD assessment.
In fact, in 2022, Minnesota even increased its rates of reimbursement for residential and outpatient services by 25%, demonstrating a commitment to behavioral healthcare as a public health issue.
Does medicaid in Minnesota pay for residential treatment? What about sober living homes?
Yes, Medicaid will cover residential treatment in Minnesota.
According to the Minnesota Department of Human Services, Medicaid covers both “room and board (when associated with SUD residential treatment)” as well as “Freestanding room and board (when associated with SUD nonresidential - outpatient - treatment).”
In other words, residential treatment - which includes room and board as part of the package - is covered under Medicaid in Minnesota. “Freestanding” room and board, which often looks like a sober living home with non-clinical services only, is also covered by Medicaid in Minnesota when it operates in association with an outpatient, “day treatment,” or IOP facility.
Some Medicaid-friendly programs in Minnesota will even accept children along with their mothers, although there are not enough programs like this in the state to meet demand. In these programs, Medicaid covers the child's room and board as well.
Does medicaid cover peer support specialists and peer support services for addiction treatment in Minnesota?
Yes.
Although peer support services rarely, if ever, exist as a stand-alone billable service, they are often an integral part of treatment and prevention programs of all kinds. Minnesota’s medicaid program recognizes the importance of these types of services and lists them in their “covered services” under “recovery peer support.”
What addiction treatment services are not covered under Minnesota’s Medicaid program?
The Minnesota Department of Human Services specifies that some addiction treatment services are not covered by Medicaid.
It’s unlikely that your program will be able to seek reimbursement from Medicaid if you:
Render any services before conducting a comprehensive assessment
Attempt to bill for “medically unnecessary” room and board expenses
Attempt to bill Medicaid for services that would otherwise be covered by a managed care plan
Offer detoxification services outside of residential withdrawal management
If you want to maximize your claim’s success with Minnesota Medicaid, be sure to steer clear of these practices.
What does the Direct Access program do for Medicaid patients trying to access addiction treatment services in Minnesota?
Direct Access is a program in Minnesota instituted in recent years to remove barriers to care for people with Substance Use Disorder. Rather than requiring preauthorization or requiring a patient to go through their Primary Care Physician (which they may or may not have), Direct Access enables patients to go directly to the program or provider they’d like to engage.
Once in contact with their target provider, patients undergo a comprehensive assessment and are able to access services immediately, without any additional hoops or steps to navigate.
How do recent reforms around ASAM levels of care in Minnesota’s Medicaid program affect addiction treatment organizations in the state?
Minnesota recently passed laws requiring addiction treatment providers to conform to ASAM levels of care if they want to continue to work with Medicaid patients.
The roll out for this change is happening in stages, with residential levels of care coming online as early as January 2024 and outpatient levels of care following suit as early as January 2025. This change has big implications for service providers in the state. Among other things, these laws mean that all addiction treatment programs competing for Medicaid dollars must offer medication assisted treatment or atleast accept patients that opt for this modality as part of their larger treatment plan and facilitate reasonable access to MAT for all patients.
This means that addiction treatment programs taking Medicaid dollars in Minnesota may not exclude patients who take buprenorphine, methadone or other addiction treatment medications.
What is medicaid in Minnesota called and where can patients apply for benefits?
Medicaid in Minnesota is simply called “Medical Assistance.” Unlike other state plans, Medicaid in Minnesota does not have a commercial-sounding name. Patients can apply here.
Minnesota also has a public healthcare option for individuals who don’t qualify for Medicaid but still need help covering health care expenses. This program is called MinnesotaCare.
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