Using Medi-Cal for Addiction Treatment in California: Everything You Need to Know

One of the most common reasons people delay or avoid addiction treatment is cost. The good news for Californians is that Medi-Cal — the state’s Medicaid program — covers a comprehensive range of substance use disorder treatment services, and eligibility is broader than many people realize. If you have Medi-Cal, you may already have the coverage you need to get help today.

This guide explains how Medi-Cal’s substance use disorder benefits work, who qualifies, what services are covered, and how to use your coverage to access treatment.

What Is Medi-Cal?

Medi-Cal is California’s Medicaid program, providing health coverage to low-income individuals and families, including children, pregnant women, people with disabilities, and adults with limited income. As of 2024, more than 14 million Californians are enrolled in Medi-Cal — nearly one in three state residents.

Under the Affordable Care Act (ACA), substance use disorder treatment was designated as one of ten essential health benefits, meaning that all Medicaid programs, including Medi-Cal, are required to cover these services. California has taken this mandate further, investing substantially in expanding the depth and quality of covered substance use treatment services.

Who Qualifies for Medi-Cal?

Medi-Cal eligibility is primarily based on income, with different categories serving different populations. As of 2024, the major eligibility groups include:

Adults ages 19 to 64 with household income at or below 138 percent of the Federal Poverty Level (approximately $20,120 for an individual, $27,214 for a couple in 2024)
Children and teenagers under 19 with family income at or below 266 percent of the FPL under the Children’s Health Insurance Program (CHIP)
Pregnant individuals, regardless of immigration status, if income qualifies
People who are blind, disabled, or receiving Supplemental Security Income (SSI)
Foster youth up to age 26

Importantly, California has extended Medi-Cal to all income-eligible residents regardless of immigration status, including undocumented adults. This is a significant expansion that makes substance use treatment accessible to a broader population than in most other states. If you are undocumented and income-eligible, you may still qualify for Medi-Cal and access addiction treatment services.

To apply for Medi-Cal, visit Covered California (coveredca.gov) or your county’s Department of Social Services. Many substance use treatment programs can also help patients apply for Medi-Cal coverage.

What Substance Use Disorder Services Does Medi-Cal Cover?

Through the Drug Medi-Cal Organized Delivery System (DMC-ODS) — a statewide waiver program administered by the California Department of Health Care Services (DHCS) — Medi-Cal covers a comprehensive continuum of substance use disorder treatment services. These include:

Outpatient Services

Individual and group counseling
Medication-assisted treatment (MAT) visits with a prescribing provider
Case management and care coordination
Family therapy when clinically indicated

Intensive Outpatient Programs (IOP)

Nine or more hours of structured clinical services per week, including group therapy, individual counseling, and skill-building.

Partial Hospitalization / Day Treatment

20 or more hours per week of structured treatment, appropriate for people who need near-residential intensity without 24-hour care.

Residential Treatment

Medi-Cal covers short-term (30 days) and long-term (up to 90 days or more in some circumstances) residential treatment in licensed facilities. This includes adult residential programs, youth residential programs, and perinatal programs for pregnant women and mothers with young children.

Medically Managed Withdrawal (Detoxification)

Both residential and non-residential medical detoxification services are covered. Medical detox is a critical first step for people with severe physical dependence on alcohol, opioids, or benzodiazepines.

Medications for Addiction Treatment (MAT)

Medi-Cal covers all FDA-approved medications for opioid and alcohol use disorder, including:

Buprenorphine (Suboxone, Sublocade)
Methadone (through licensed OTPs)
Naltrexone (Vivitrol injectable)
Naltrexone (oral)
Acamprosate
Disulfiram

The Substance Abuse and Mental Health Services Administration (SAMHSA) has long affirmed that MAT is among the most effective treatments for opioid use disorder, reducing mortality, improving treatment retention, and reducing illicit drug use. Medi-Cal’s coverage of these medications removes a major financial barrier to accessing this life-saving care.

Recovery Support Services

Under expanded CalAIM policies, Medi-Cal now covers enhanced recovery support services including:

Recovery coaching and peer support specialists
Housing navigation and transition support
Case management to connect members with community resources

The CalAIM Expansion: What’s New

California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative, launched in 2022, represents a major transformation of how Medi-Cal delivers services. For people with substance use disorders, the most significant changes include:

Enhanced Care Management: Medi-Cal members with complex needs — including severe substance use disorders — are now eligible for Enhanced Care Management, which assigns a dedicated care manager to coordinate all of their health services.

Community Supports: CalAIM has added a menu of “community supports” that can be funded through Medi-Cal, including housing navigation, sobering centers, and recuperative care for people transitioning out of hospital stays.

Justice-Involved Individuals: CalAIM has expanded access to substance use treatment for people leaving jails and prisons, ensuring continuity of care during a high-risk period.

How to Use Your Medi-Cal Coverage for Treatment

If you already have Medi-Cal, the process for accessing substance use treatment works as follows:

Contact your Medi-Cal managed care plan — most Medi-Cal members are enrolled in a managed care health plan (such as Anthem Blue Cross, Health Net, Molina, LA Care, or others depending on county). Call the member services number on the back of your Medi-Cal card and ask about in-network substance use treatment providers.
Ask about the Drug Medi-Cal Organized Delivery System — in counties that operate the DMC-ODS, your plan can connect you to covered residential, outpatient, and MAT services.
Contact your county’s Alcohol and Drug Program (ADP) — every California county has a publicly funded alcohol and drug program that coordinates access to Medi-Cal-funded treatment. Your county ADP can conduct an assessment and connect you with appropriate services.
Tell your primary care provider — your PCP can prescribe buprenorphine directly, refer you to a behavioral health specialist, and coordinate your overall care.

What If I Don’t Have Medi-Cal?

If you do not currently have Medi-Cal and think you might qualify, you can apply at any time through Covered California or your county Department of Social Services. There is no open enrollment period for Medi-Cal — you can apply year-round, and coverage can be approved retroactively in some cases.

If you are not eligible for Medi-Cal, other options exist:

Sliding-scale and county-funded programs: Many California counties fund treatment for uninsured or underinsured residents on a sliding fee scale based on income.
SAMHSA Grants: Community health centers and federally qualified health centers (FQHCs) often receive federal grants that subsidize substance use treatment for the uninsured.
Private insurance: If you have private insurance through an employer or Covered California marketplace plan, your plan is also required to cover substance use disorder treatment as an essential health benefit under the ACA.

Take the First Step

You may have more coverage than you realize. The California Addiction Hotline can help you verify your Medi-Cal benefits, identify in-network treatment programs, and get you connected to care — at no cost to you.

Call us today. Whether you have Medi-Cal, private insurance, or no coverage at all, our counselors will help you find a pathway to treatment that works for your situation. Calls are completely confidential, and there is no obligation. Your health matters — and help is available right now.

Sources: California Department of Health Care Services (DHCS); Substance Abuse and Mental Health Services Administration (SAMHSA); Centers for Disease Control and Prevention (CDC); National Institute on Drug Abuse (NIDA); Covered California