After extensive consultation with health care providers, counties, tribes, and other stakeholders, Wisconsin will cover the treatment for substance use disorder in a residential setting for members of most of its Medicaid programs beginning February 1. The treatment offered uses a “whole patient” approach that is clinically effective, reduces overdoses and deaths, and helps people sustain recovery. Health care providers will determine whether their patients require this level of care using criteria from the American Society of Addiction Medicine.

“Addiction doesn’t just affect the individual,” said Wisconsin Medicaid Director Jim Jones. “It affects their families, loved ones, and communities. The services offered under this benefit are critical to providing the most appropriate level of care for many of those dealing with severe and long-term addictions.”

Services offered in the residential setting under this benefit include: assessment and treatment planning, counseling, medication management, case management, peer support, and recovery coaching. Medication-assisted treatment is also included, because the use of certain medications to relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body must be available to members when clinically recommended.

Since 2017, Wisconsin’s Medicaid program has covered residential substance use disorder treatment on a limited basis through the Comprehensive Community Services program, allowing treatment in smaller facilities with 16 or fewer beds. The new benefit will be offered under a Section 1115 Waiver from the Centers for Medicare & Medicaid Services to cover treatment in larger treatment facilities, which account for approximately 2/3 of the available beds in the state’s residential substance use disorder treatment facilities certified by the Department of Health Services Division of Quality Assurance.

While the benefit covers treatment, Medicaid cannot cover room and board expenses related to residential substance use disorder treatment. Members will need to use other sources to pay for room and board. The benefit also does not include coverage in non-treatment residential settings, such as sober living homes, recovery residences, or community living arrangements.

Information and statistics about substance use disorders can be found on the DHS website. People looking for substance use treatment and recovery services are encouraged to use the Wisconsin Addiction Recovery Helpline. The helpline is free, confidential, and available 24/7.