TennCare, a statewide Medicaid plan in Tennessee, provides insurance coverage for nearly 1.4 million people throughout the state. The people served through TennCare primarily include low-income pregnant women and families, those with disabilities, and seniors.
First established in 1994, TennCare is one of the oldest Medicaid programs in the United States. All services offered through TennCare are provided through Managed Care Organizations, or MCO’s. Being a Medicaid led program, TennCare offers coverage for Medicaid plans ranging from A-M. TennCare is one of the most widely accepted forms of insurance in addiction treatment programs throughout the state, allowing those who do not have the independent means to pay for treatment to receive it.
What Does TennCare Cover?
According to Tennessee’s Department of Mental Health and Substance Abuse Services, the addiction treatment services that TennCare can provide coverage for include the following:
- Residential treatment
- Partial hospitalization programs
- Intensive outpatient programs
- Outpatient treatment
- Halfway House
- Social detox
- Medically monitored detox
Members of TennCare are only eligible for coverage of the above-listed services, according to the state’s Department of Mental Health and Substance Abuse Services, if:
- They do not have the financial ability to obtain services
- They do not have financial means to obtain services through the TennCare program
- They meet federal poverty guidelines
- They are not enrolled in TennCare
- They do not have a third party health benefits payor source
- They have utilized all the drug abuse treatment options through TennCare or other third-party insurance company
Again, prior to making any decisions regarding what services to obtain or where to go for treatment, consult with TennCare to determine coverage options.
Inpatient Addiction Treatment vs. Outpatient
Not everyone who struggles with addiction is going to benefit from the exact same type of professional treatment. To better serve all populations of those who are looking to overcome the challenges associated with substance use disorder, a number of different treatment approaches are offered. Two of the most popular include inpatient and outpatient addiction treatment.
Inpatient addiction treatment is the top-tier of all treatment programs. When enrolled in an inpatient addiction treatment program, clients will be provided with a personalized treatment plan that can include several different services. Most commonly, the first service that those who enter into inpatient treatment receive is detox. During this time, clients are medically-assisted as they work to rid their bodies of any and all addictive substances they have been abusing. When detox is completed and the client is stable, he or she then moves into the therapeutic process of addiction treatment, which can include participation in therapies such as individual, group, behavioral, experiential, and family therapies. As the time comes to transition out of treatment, clients work with their therapists and other professionals to make a continued care plan so that they can keep on the path of recovery.
Outpatient addiction treatment shares the same goal of inpatient addiction treatment, which is to help those who need treatment for substance use disorders get it and achieve success as a result. However, outpatient treatment is not as hands-on as inpatient addiction treatment is. Instead, those who are enrolled in an outpatient treatment program only go to the facility for a few hours a day a couple of times a week to receive treatment. The majority of the client’s time spent in outpatient treatment will be in individual and group therapy sessions, as well as any other type of therapy sessions deemed potentially helpful for his or her recovery. Clients of outpatient treatment can continue to live at home and go to work or school, as it is easy to incorporate their treatment into their everyday lives.
Inpatient and outpatient treatment are mostly different due to the types of clients they serve. Inpatient treatment programs tend to see those who have severe substance use disorders, require medical detox, or who have been unsuccessful at getting sober in the past. Clients of an outpatient treatment program typically either have a mild substance use disorder or have transitioned into the program from an inpatient or another more intensive care program.
Verifying Coverage and Finding the Best, Most Appropriate Treatment
Not all addiction treatment programs accept TennCare, which is why it is important to check with a TennCare representative prior to enrolling in a treatment program. Speaking with a representative at TennCare can also guide members towards services that can benefit them, as well as help, inform them of what level of coverage they have for these services. Each member of TennCare has his or her own plan that has been developed based on his or her own personal details. This means that while one person might be eligible for full coverage, another person might not. Therefore, being aware of one’s coverage options is vital prior to beginning treatment.