Does Molina Healthcare Cover Rehab? What Your Plan Pays For

Molina Healthcare is a specialized health insurance company focusing on government-sponsored programs, primarily Medicaid managed care. Molina covers approximately 5 million members across 15 states, making it one of the largest Medicaid managed care organizations in the United States. Unlike commercial insurers that primarily serve employer-sponsored plans, Molina’s mission centers on providing care to lower-income individuals and families enrolled in Medicaid, Medicare-Medicaid dual eligible programs, and ACA Marketplace plans.

Understanding Molina’s Focus on Medicaid

Molina Healthcare is fundamentally different from carriers like Aetna, Cigna, or UnitedHealthcare:

Medicaid Managed Care Model

State contracts: Molina contracts with state Medicaid programs to provide managed care services. Each state has different benefit structures, provider networks, and coverage rules.

Target population: Low-income individuals and families who qualify for Medicaid based on income, disability, pregnancy, or other factors.

Benefits: Medicaid benefits are typically more comprehensive than commercial insurance, with low or $0 copays and no deductibles.

Provider networks: Molina networks emphasize community health centers, safety-net hospitals, and providers who traditionally serve Medicaid populations.

States Where Molina Operates

Molina Healthcare operates Medicaid managed care in 15 states:

• California
• Florida
• Idaho
• Illinois
• Kentucky
• Massachusetts
• Michigan
• Mississippi
• Nevada
• New Mexico
• New York
• Ohio
• South Carolina
• Texas
• Virginia
• Washington
• Wisconsin

Coverage specifics, provider networks, and addiction treatment benefits vary significantly by state.

What Does Molina Healthcare Cover for Rehab?

Under federal Medicaid law and the Mental Health Parity and Addiction Equity Act, Molina Medicaid plans must cover substance use disorder treatment:

Covered Services

Medical Detoxification — Medically supervised withdrawal in hospital or detox facilities. Typically $0 copay for Medicaid members. Duration based on medical necessity, typically 3-14 days.

Inpatient/Residential Treatment — 24/7 residential programs. Medicaid members typically have $0 copay. Marketplace plan copays vary. Initial authorization typically 7-14 days with concurrent review for continued stay. Some states limit residential treatment days per year.

Partial Hospitalization Program (PHP) — Intensive day treatment 6+ hours daily. Typically $0 copay for Medicaid.

Intensive Outpatient Program (IOP) — Structured outpatient treatment 9-15 hours weekly. Typically $0 copay for Medicaid.

Outpatient Therapy — Individual and group counseling. Typically $0 copay for Medicaid members, often provided at community mental health centers or substance abuse treatment agencies.

Medication-Assisted Treatment (MAT) — All FDA-approved medications:

• Buprenorphine (Suboxone, generic buprenorphine/naloxone, Sublocade injection)
• Methadone through certified opioid treatment programs (OTPs)
• Naltrexone (Vivitrol injection, ReVia tablets)
• Acamprosate (Campral)
• Disulfiram (Antabuse)

Medicaid MAT copays: Typically $0-$5 per prescription. Many states have eliminated prior authorization for buprenorphine to improve access.

Molina Plan Types

Molina Medicaid (Primary Focus)

Eligibility: Income-based or categorical (pregnant women, children, individuals with disabilities, etc.)

Coverage: Comprehensive with minimal cost-sharing Copays: $0 for most services, $1-$5 for some services (varies by state) Deductible: None Network: Must use in-network providers (HMO model) Typical out-of-pocket for 30-day inpatient: $0-$50

Molina Medicaid provides the most comprehensive addiction treatment coverage with minimal financial barriers.

Molina Marketplace (ACA)

Eligibility: Available during open enrollment or with qualifying life event

Coverage: ACA-compliant essential health benefits Copays/Coinsurance: Varies by metal tier (Bronze, Silver, Gold) Deductible: Yes, varies by plan Network: In-network only or limited out-of-network (varies by plan) Typical out-of-pocket for 30-day inpatient: $3,000-$12,000 depending on metal tier

Molina Marketplace plans available in select states (CA, FL, MI, others).

Molina Medicare-Medicaid Plan (Dual Eligible)

Eligibility: Individuals eligible for both Medicare and Medicaid

Coverage: Combined Medicare and Medicaid benefits Copays: Typically $0 due to Medicaid coverage Deductible: Typically $0 Network: Must use in-network providers Typical out-of-pocket for 30-day inpatient: $0-$100

Dual eligible plans offer comprehensive coverage for seniors and individuals with disabilities who qualify for both programs.

Accessing Addiction Treatment Through Molina Medicaid

The process for accessing treatment varies by state but generally follows this pattern:

Step 1: Determine Medical Necessity

Options:

• Contact Molina’s behavioral health line (number on member card)
• Contact your primary care provider
• Visit emergency department if in crisis
• Contact community mental health center

Step 2: Assessment

• Initial assessment determines appropriate level of care
• May be conducted by Molina care coordinator, community mental health center, or treatment facility
• Uses ASAM criteria or state-specific medical necessity criteria

Step 3: Preauthorization

• Facility submits preauthorization request to Molina
• Molina’s behavioral health team reviews using state Medicaid criteria
• Decision typically within 24-72 hours

Step 4: Treatment

• You receive treatment at Molina-contracted facility
• Typically $0 copay for Medicaid members
• Concurrent reviews every 3-7 days

Step 5: Step-Down Care

• Molina coordinates transition to lower levels of care
• Follow-up at community mental health centers or outpatient providers
• MAT initiated or continued through Medicaid providers

State-Specific Molina Coverage Examples

Addiction treatment benefits vary significantly by state:

California Molina Medicaid (Medi-Cal)

Strengths:

• Comprehensive Drug Medi-Cal (DMC) services
• No copays for substance abuse treatment
• Extensive network of county-certified providers
• Strong MAT access

Limitations:

• Some residential programs may have waitlists
• Must use in-network providers

Texas Molina Medicaid

Strengths:

• No copays for substance abuse services
• Growing network of treatment providers
• MAT coverage improving

Limitations:

• Network smaller than some other states
• Rural access limited

Ohio Molina Medicaid

Strengths:

• Comprehensive substance abuse benefits
• No copays
• Strong community-based treatment network

Limitations:

• Some residential facilities have capacity constraints
• Network primarily community-based rather than private facilities

New York Molina Medicaid

Strengths:

• Extensive NYC metro network
• No copays
• Strong residential treatment access

Limitations:

• Network less robust in upstate regions
• Some high-end facilities not contracted

Typical Out-of-Pocket Costs with Molina

Molina Medicaid (Most Common)

Plan structure:

• Deductible: $0
• Copays: $0 for most services

30-day inpatient program:

• Member cost: $0

Medical detox (7 days):

• Member cost: $0

Outpatient therapy:

• Member cost: $0 per visit

MAT medications:

• Generic buprenorphine: $0-$3
• Brand Suboxone: $3-$5 (if covered; generics preferred)
• Vivitrol: $0-$5
• Methadone (OTP): $0-$1 per day

Molina Marketplace Silver Plan (Example)

Plan structure:

• Deductible: $1,500
• Coinsurance: 80/20
• Out-of-pocket maximum: $7,000

30-day inpatient program:

• Facility cost: $28,000
• You pay: $1,500 (deductible) + 20% of $26,500 ($5,300) = $6,800

MAT medications:

• Generic buprenorphine: $20-$50/month
• Vivitrol: $100-$200/month

Verifying Your Molina Coverage

Call Molina Behavioral Health

Phone: Number on your member card (varies by state)

• California: 1-888-665-4621
• Texas: 1-866-449-6849
• Ohio: 1-855-322-4075
• Other states: Check member card or Molina website

Questions to ask:

• What substance abuse treatment services are covered by my plan?
• Is [facility name] in-network?
• What are my copays for inpatient treatment?
• How does preauthorization work?
• Does my state Medicaid program limit inpatient days per year?
• What MAT medications are covered?
• Are there any barriers or prior authorizations for MAT?

Check Online

Molina member portal: MolinaHealthcare.com (by state)

• Find providers in your state’s network
• View your benefits
• Check claims

Contact the Facility

Treatment facilities that accept Molina can:

• Verify your Molina benefits
• Explain coverage for their specific program
• Initiate preauthorization
• Explain any out-of-pocket costs

Molina’s Behavioral Health Network

Molina’s provider networks emphasize community-based care:

Network characteristics:

• Community mental health centers — Primary outpatient providers
• Safety-net hospitals — Inpatient detox and stabilization
• Community-based residential programs — Less common than high-end private facilities
• Opioid treatment programs (OTPs) — Methadone maintenance
• FQHC and county clinics — Primary care-based MAT

Network size: Approximately 900+ addiction treatment facilities across 15 states (varies significantly by state)

Strengths:

• Good access to outpatient services
• Strong MAT provider networks in most states
• Community-based care coordination

Limitations:

• Fewer high-end residential facilities
• Limited luxury or executive rehab options
• Rural areas may have access challenges

What Makes Molina Different

Focus on Underserved Populations

Molina’s mission is serving Medicaid-eligible populations, emphasizing:

• Cultural competency
• Language access (interpretation services)
• Care coordination for complex cases
• Social determinants of health

Integrated Care Management

Molina provides care coordination for members with complex needs:

• Care managers for high-risk members
• Coordination between physical and behavioral health
• Community health workers in some states
• Connections to social services

Low Financial Barriers

Medicaid’s minimal cost-sharing removes financial barriers to treatment that exist with commercial insurance.

Limitations and Challenges with Molina

Network Restrictions

• Must stay in-network (HMO model)
• Out-of-network care generally not covered
• Fewer choices than PPO plans from commercial carriers

State Variability

• Benefits vary significantly by state
• Network adequacy differs by state
• Some states have annual limits on inpatient days

Facility Mix

• Network emphasizes community-based care over private facilities
• High-end residential treatment centers less commonly contracted
• May not include specialized programs (wilderness therapy, equine therapy, etc.)

Don’t Have Molina (and Need Coverage Options)?

If you’re currently uninsured and seeking addiction treatment:

Medicaid Eligibility

Check if you qualify for Medicaid in your state:

• Income-based eligibility (varies by state, generally up to 138% of federal poverty level in expansion states)
• Categorical eligibility (pregnancy, disability, etc.)
• Children and teens have higher income thresholds

To apply: Contact your state Medicaid office or visit Healthcare.gov

ACA Marketplace

If income is too high for Medicaid:

• Subsidies available for incomes 100-400% of federal poverty level
• Special enrollment periods for qualifying life events
• Can choose from multiple carriers beyond Molina

A licensed insurance specialist can help you:

• Determine Medicaid eligibility
• Navigate ACA marketplace enrollment
• Compare plan options
• Understand your coverage for addiction treatment

Sources

• Molina Healthcare. “Behavioral Health Services.” State-Specific Member Handbooks. 2026.
• Centers for Medicare & Medicaid Services. “Medicaid Benefits: Mental Health and Substance Use Disorder Services.” 2024.
• Medicaid.gov. “Managed Care.” 2026.
• State Medicaid Programs. “Substance Use Disorder Benefits.” Various states, 2024-2026.