Does Pennsylvania Medicaid Cover Methadone?

Methadone is one of three legal, long-acting medications approved by the FDA to treat opioid use disorder. However, coverage of this medicine varies by state and insurance. Pennsylvania does cover methadone treatment services. For individuals and loved ones seeking recovery, work with a treatment professional to find the best options for you!

What is Methadone?

Methadone is a drug used to treat Opioid Use Disorder. Methadone, a medication-assisted treatment (MAT), helps people by reducing opioid craving and withdrawal symptoms. Methadone treats heroin dependence by normalizing body and brain functions and hormones that are impaired by heroin use. Methadone is a replacement therapy medication that leads to reduced drug use, reduced risk of HIV, improved physical health, improved psychological health, reduced criminal behavior, and improved social adjustment. By law, methadone is only dispensed through certified opioid treatment program facilities.

Individuals in treatment receive a daily oral dosage of methadone as an element of a full treatment plan, whether that plan be short term detoxification or long term maintenance. This drug is an important part of an addiction treatment plan that helps people have long term success. It is most effective when paired with counseling, education, and support.

What is Medicaid?

Medicaid is a health coverage program that covers eligible low-income Americans. It is also known as Medical Assistance, or “MA.” Medicaid is administered by state, but also receives federal requirements and funding. As of March 2020, 64.1 million people were covered through Medicaid. Learn how to apply for Medicaid in Pennsylvania here.

Pennsylvania Medicaid and Methadone

Yes, methadone treatment is covered in the state of Pennsylvania, through MCOs.

The PA Department of Public Welfare released the following statement about why methadone is a covered treatment:

Methadone treatment services are included in the Pennsylvania State Plan as a covered service under Medicaid because they are effective in treating heroin and other opioid dependence. Methadone treatment consists of either short term detoxification or longer term maintenance and is offered in conjunction with counseling and other supports. PA is among 43 states that provide methadone treatment services under their Medicaid Program as a treatment option for opioid dependence.

The Pennsylvania Department of Human Services functions through HealthChoices. Mental health and drug and alcohol services, which could include methadone treatment care, are provided through your county’s contracted Managed Care Organization (MCO). For methadone coverage approval, individuals need to first be in a treatment program.

For individuals eligible for services under the Fee-For-Service program, see this list for county assistance contact information.

The Medical Assistance Transportation Program (MATP) often will pay people to transport themselves to methadone treatment centers. Typically, methadone is administered daily and in-person onsite clinical treatment locations. However, physicians can authorize specific quantities of take home doses once an individual is stable and successful meets responsibility and education requirements. The goal is to safely provide as much support as possible.

Since methadone is provided in conjunction with step-treatment plans and therapy, the most important first step is seeking help from a medical provider. Methadone treatment services, dispensed through certified opioid treatment programs, will help you correctly navigate program eligibility and the right steps towards recovery and a stable, healthy life. Treatment programs will guide you through the process, aiming to lead you to long-term success.