Does Medi-Cal Cover Sober Livings?

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For some individuals, transitioning into a sober living facility prior to returning home can be beneficial. Many individuals that struggled with substance abuse and/ or addiction will have prioritized satisfying drug cravings above all else. This can wreak havoc in all areas of one’s life and result in financial strain, legal complications, relationship rifts, and more. According to the National Institute on Drug Abuse (NIDA), the length of time an individual spends in substance abuse treatment (including sober living) can directly increase his or her outcome in recovery. Sober livings are intended to be a stepping-stone that helps to transition an individual out of a treatment program and further prepares them for returning to their home lives. Sober living homes are often privately owned organizations, and each sober living facility is different. It is important to note that sober living homes, by definition, are not medical facilities. As such, very few insurance companies can provide any type of coverage or payout towards the expenses related to residing in a sober living facility.

What Is Medi-Cal?

Medi-Cal is California’s Medicaid health care program that offers low-cost health care coverage for eligible individuals. While Medicaid is operated at a state level, the Centers for Medicare & Medicaid Services explains that Medicaid as a whole “provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.” The Mental Health Parity and Addiction Equity Act (MHPAEA), which was passed into federal law 1996, requires health insurance providers, including those underwritten by Medicaid, to offer benefits for substance abuse and mental health services that are equal to those for other medical and surgical services. 

In 2015, the Centers for Medicare and Medicaid Services (CMS) approved California’s Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver amendment which provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) criteria for substance use disorder treatment services. Medi-Cal does provide coverage for eligible members struggling with substance abuse and/ or addiction to obtain treatment at a Drug Medi-Cal certified program. Since most sober living homes privately owned facilities and are not recognized as a component of residential treatment services, Medi-Cal generally does not provide coverage for residing in a sober living home.

For Information and Support 

If you are concerned for yourself or a loved one regarding substance abuse and/ or addiction we recommend reaching out for help as soon as possible. If left untreated, substance abuse can result in long lasting and potentially life-threatening consequences. Keep in mind: you are not alone! There is an entire network of professionals that are available to help and support you and your loved one throughout the recovery process. The earlier you seek support, the sooner your loved one can return to a happy, healthy, and fulfilling life.

Please do not hesitate to reach out with any questions regarding our specific program at Haven House Addiction Treatment and/ or general substance abuse and/ or addiction treatment related information. Our highly trained staff is readily available to discuss how we might best be able to help you and your loved one. We can be reached by phone at 424-318-3777. You are also welcomed to contact anytime us via email at admissions@hhtxc.com.

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