Key points
- Yes. Ohio Medicaid covers residential treatment for substance use disorders in state-certified facilities as a 24-hour treatment setting, and it covers withdrawal management (medical detox) within that level of care.
- Most Ohio Medicaid members get their benefits through a managed care plan, and the plan reviews medical necessity. Coverage check happens on the call.
- Oak Grove Recovery in Westerville, just north of Columbus, accepts Ohio Medicaid, commercial insurance, and private pay, and provides medical detox and residential treatment under one roof.
- Admissions answers 24/7 at 614.324.8137. Same-day admission available. We arrange transportation 24/7.
In this article
- The short answer
- What Ohio Medicaid covers for substance use
- Managed care plans and prior authorization
- Medical detox under the same benefit
- If you do not have Ohio Medicaid yet
- What treatment at Oak Grove Recovery includes
- What happens on the call
- Frequently asked questions
- Call admissions
- Sources
The short answer
Yes. Ohio Medicaid covers residential treatment for substance use disorders when a person meets the criteria for that level of care, and it covers withdrawal management as well. What any one member’s plan approves is decided through a benefit review, and the fastest way to find out is to call. Oak Grove Recovery accepts Ohio Medicaid. Coverage check happens on the call.
What Ohio Medicaid covers for substance use
Ohio’s Medicaid rules list “substance use disorder residential level of care” among covered behavioral health services [1]. The rule that defines that level of care describes it as care provided by substance use treatment, mental health, and general medical personnel “in a twenty four hour treatment setting,” and it includes withdrawal management within that residential and inpatient level [2].
The same rule spells out what a residential stay includes: ongoing assessments and diagnostic evaluations, crisis intervention, individual, group, and family psychotherapy and counseling, case management, peer recovery services, urine drug screens, and medical services [2]. In plain terms, Ohio Medicaid pays for the clinical care of a residential stay. Room and board is listed separately as a non-covered item under the behavioral health rule [1], which is one reason the coverage conversation belongs on the call rather than on a web page.
Managed care plans and prior authorization
Most Ohio Medicaid members receive their benefits through a managed care plan. Your plan’s name is on your card, and the plan is who reviews whether a residential stay is medically necessary.
Ohio’s rules allow a residential stay to begin and require prior authorization to continue past a set point, based on medical necessity, with earlier authorization for repeat admissions in the same calendar year [2]. Admissions handles that conversation with your plan. Two things follow from it. First, a residential stay is approved based on a clinical assessment, which is why the admissions call asks real questions about your use and your health. Second, how long you stay is determined by medical necessity, not a set number of days.
Medical detox under the same benefit
For many people, withdrawal management (medical detox) comes first, and Ohio’s rules include it within the residential and inpatient level of care [2]. At Oak Grove Recovery, medical detox means medically supervised withdrawal management with 24/7 nursing support and physician oversight, with qualified medical providers evaluating medication needs along the way. Our medical detox page describes the program.
Detox is a first stage, not the whole of treatment. NIDA’s principles of effective care say medically assisted detoxification “is only the first stage” and should be followed by ongoing care [3], which is why discharge planning starts when you arrive.
If you do not have Ohio Medicaid yet
You do not need to sort out coverage before you call. Admissions can talk through where you are either way. If you want to start an application, Ohio Benefits is the state’s online portal; its self-service portal lets Ohioans start an application for medical assistance [4]. In Franklin County, Job and Family Services determines Medicaid eligibility and can be reached at 1-844-640-6446 [5]. If you live in another county, your county’s Job and Family Services office does the same.
Have whatever you have ready, even if that is nothing yet. The call still happens.
What treatment at Oak Grove Recovery includes
Oak Grove Recovery, at 690 Cooper Rd in Westerville, provides medical detox and residential treatment for adults 18 and older, men and women. Residential treatment includes individual therapy, group therapy, and family therapy (in person or virtual), with co-occurring mental health conditions treated alongside substance use. Medication for opioid use disorder is available as part of a treatment plan, and qualified medical providers evaluate medication needs for each person. Pregnant women are welcome, and couples are welcome. Oak Grove Recovery is accredited by The Joint Commission.
NIDA notes that “no single treatment is appropriate for everyone” and that effective treatment attends to a person’s multiple needs, not only their substance use [3]. Discharge planning starts when you arrive, as part of your treatment plan. Our Ohio Medicaid page has more on coverage.
What happens on the call
Call 614.324.8137. Admissions answers 24/7. The team asks about what you are using, how long it has been going on, your health, and what has happened when you tried to stop before. Have your Ohio Medicaid card or member ID nearby if you can; if you do not, the call still happens.
Admissions verifies your benefits on the call and handles the authorization conversation with your plan. Checking your coverage doesn’t mean you’ve decided anything. It just means you’ll know. Same-day admission available. We arrange transportation 24/7. Oak Grove Recovery also accepts commercial insurance and private pay. Both Medicaid and commercial insurance are accepted; neither undercuts the other.
Call admissions
If you are in Columbus, Westerville, or anywhere in Franklin County and wondering whether Ohio Medicaid will cover detox or residential treatment, call 614.324.8137. Admissions answers 24/7, checks your coverage on the call, and talks through the right first step. Checking your coverage doesn’t mean you’ve decided anything. It just means you’ll know.
Sources
- Ohio Administrative Code 5160-27-02, Coverage and limitations of behavioral health services (effective July 1, 2022). https://codes.ohio.gov/ohio-administrative-code/rule-5160-27-02
- Ohio Administrative Code 5160-27-09, Substance use disorder treatment services (effective January 1, 2018). https://codes.ohio.gov/ohio-administrative-code/rule-5160-27-09
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf
- Ohio Benefits (Ohio Department of Job and Family Services). https://benefits.ohio.gov/
- Franklin County, Ohio. Job and Family Services. https://www.franklincountyohio.gov/Agency-Directory/Job-and-Family-Services
