MEDICAID
Medicaid Coverage for Addiction Treatment in Albany, NY
Don’t let cost or insurance questions get in the way of recovery. At Fusion Recovery in Albany, NY, our admissions team will verify your New York Medicaid benefits, walk you through what’s covered, and help you start treatment, usually with little to no out-of-pocket cost.
START HEALING TODAY
Personalized Outpatient Treatment for Albany Residents
At Fusion Recovery, we understand the weight that addiction places on your life and the lives of those you love. That’s why we offer personalized outpatient addiction treatment built around your specific situation, your goals, your schedule, and your recovery needs.
As an outpatient rehab serving the Albany, NY region, we provide flexible scheduling so you can stay engaged with work, family, and other commitments while getting the help you deserve. New York’s Medicaid program is one of the most generous in the country when it comes to substance use disorder coverage, and we work with members across all of the state’s Medicaid Managed Care plans, HARP plans, fee-for-service Medicaid, and dual-eligible plans.
If you or someone you love is struggling, contact us today. Our admissions team will verify your Medicaid benefits, walk you through your treatment options, and help you take the next step at no cost and with no pressure.
ABOUT NEW YORK MEDICAID
Understanding New York Medicaid Coverage for Addiction Treatment
Medicaid is a joint federal-state program that provides comprehensive health coverage to low-income New Yorkers, including coverage for substance use disorder treatment. New York’s Medicaid program is administered by the New York State Department of Health and consistently ranks as one of the most generous Medicaid programs in the country, particularly for behavioral health and addiction services.
Most New York Medicaid recipients receive their benefits through Medicaid Managed Care (MMC), meaning their coverage is administered by a private health plan that contracts with New York State to provide Medicaid services. The major Medicaid Managed Care plans in the Capital Region include Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, CDPHP, and others. A smaller number of New Yorkers receive coverage through fee-for-service Medicaid (also called “straight Medicaid”), where providers bill the state directly.
Under federal Medicaid rules, the Affordable Care Act, and New York State Insurance Law, Medicaid plans must cover medically necessary substance use disorder treatment. New York Medicaid also caps total out-of-pocket costs at $200 per calendar year for inpatient or outpatient rehab, and most managed care plans charge $0 or near-zero copays for SUD services.
NEW YORK MEDICAID PLAN TYPES
Common Medicaid Plans in Albany
Medicaid Managed Care (MMC)
Most New York Medicaid recipients are enrolled in Medicaid Managed Care, where their benefits are administered by a private health plan. In the Capital Region, MMC plans include Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, CDPHP, and others. All MMC plans must cover the same comprehensive substance use disorder benefits, but provider networks may differ.
HARP (Health and Recovery Plans)
HARP is a special Medicaid Managed Care product designed for adults aged 21+ with significant behavioral health needs. HARP enrollees get all standard Medicaid benefits plus enhanced “Home and Community Based Services” (HCBS) for behavioral health, including peer support, employment supports, family support and training, and enhanced care coordination through Health Homes. If you have a serious mental health condition or significant SUD, you may be eligible for HARP enrollment.
Fee-for-Service Medicaid (Straight Medicaid)
A smaller portion of New York Medicaid recipients are not enrolled in managed care, including some people with specific eligibility categories. Fee-for-service Medicaid recipients have providers bill the state directly through eMedNY.
Medicaid Advantage Plus & Dual Special Needs Plans
For New Yorkers eligible for both Medicare and Medicaid (“dual eligibles”), several integrated plan options combine the two coverages, often with $0 monthly premium and very low cost-sharing. Examples include Medicaid Advantage Plus and Dual Special Needs Plans (D-SNPs).
Essential Plan
Although technically not Medicaid, the New York Essential Plan offers Medicaid-like coverage with $0 monthly premium and $0 deductible for New Yorkers with incomes up to 250% of the Federal Poverty Level who don’t qualify for Medicaid. The Essential Plan also covers comprehensive substance use disorder treatment, including MAT and inpatient/outpatient rehab.
Child Health Plus
New York’s CHIP-equivalent program provides free or low-cost coverage for children under age 19. Behavioral health and substance use disorder treatment are covered benefits.
OVERVIEW OF MEDICAID BENEFITS
What New York Medicaid Covers at Fusion Recovery
New York Medicaid is exceptionally comprehensive for substance use disorder treatment. Most members have access to the full continuum of care.
Treatment services are typically covered
- Medically supervised detox and withdrawal management
- Inpatient and residential addiction treatment at OASAS-licensed facilities
- Partial hospitalization programs (PHP)
- Intensive outpatient programs (IOP)
- Standard outpatient treatment
- Individual, group, and family therapy
- Medication-assisted treatment (MAT), including Sublocade, Suboxone, methadone, naltrexone, and Vivitrol
- Opioid Treatment Program (OTP) services, including methadone maintenance
- Dual diagnosis care for co-occurring mental health conditions
- Mobile crisis services and crisis stabilization
- Peer support and recovery coaching (especially for HARP enrollees)
- Care coordination through Health Homes
Coverage Details
New York Medicaid is one of the lowest-cost insurance options for addiction treatment available, most managed care members pay $0 or near-zero copays for substance use disorder services. New York Medicaid rules also cap total out-of-pocket costs at $200 per calendar year for both inpatient and outpatient rehab combined.
There are no deductibles for Medicaid Managed Care members, and no annual or lifetime limits on medically necessary substance use disorder treatment. The Essential Plan also offers $0 monthly premium and $0 deductible for eligible New Yorkers.
LOCADTR-based clinical reviews
For substance use disorder treatment, New York Medicaid plans use LOCADTR 3.0, the Level of Care for Alcohol and Drug Treatment Referral tool developed by NYS OASAS and Columbia University. LOCADTR is the New York-mandated equivalent of the ASAM Criteria and determines the appropriate level of care based on a comprehensive clinical assessment. Our clinical team is fully fluent in LOCADTR documentation.
Preauthorization requirements
Many New York Medicaid plans don’t require prior authorization for outpatient substance use treatment, but most require authorization for inpatient or residential admission, partial hospitalization, and intensive outpatient programs. Under New York State Insurance Law changes, prior authorization is generally not required for FDA-approved medications used to treat substance use disorder. Fusion Recovery handles authorizations and continued-stay reviews on your behalf.
Call Now to Verify Your Coverage
HOW IT WORKS
How to Verify Your Medicaid Benefits
Verification is fast, free, and fully confidential. Here’s how it works:
01.
Share your details
Call us at 1.866.936.2290 or fill out our contact form with your Medicaid CIN (Client Identification Number) or Medicaid Managed Care plan member ID. Let us know whether you have straight Medicaid, MMC, HARP, Essential Plan, or a dual-eligible plan if known.
02.
We verify your benefits
Our team contacts your Medicaid plan (or eMedNY for fee-for-service Medicaid) to confirm in-network status, copays, prior authorization requirements, and what level of care is covered.
03.
We explain your options
We walk you through your benefits in plain language, outline any out-of-pocket costs (which are usually minimal), and recommend the level of care that fits your needs.
04.
You take the next step
When you’re ready, we schedule your clinical assessment and help you begin treatment, often the same day.
WHAT WE TREAT
Conditions We Treat at Fusion Recovery
Our Albany, NY treatment programs serve adults struggling with a wide range of substance use and co-occurring mental health conditions, including:
- Alcohol use disorder
- Opiate and prescription painkiller addiction
- Heroin addiction
- Fentanyl addiction
- Cocaine addiction
- Methamphetamine addiction
- Benzodiazepine dependence
- Co-occurring depression, anxiety, PTSD, and other mental health conditions
Ready to Take the First Step?
Recovery begins when you reach out. Our admissions team is available to verify your New York Medicaid coverage, navigate any required authorizations, and help you start treatment in Albany, NY. Cost should never stand in the way of recovery, and with NY Medicaid, it usually doesn’t have to. Call anytime.
Frequently Asked Questions
01. Is Fusion Recovery in-network with New York Medicaid?
Fusion Recovery may be in-network with New York Medicaid Managed Care plans serving Albany, NY, and the surrounding Capital Region. Network status varies by your specific plan, Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, CDPHP, etc. We recommend calling our admissions team at 1.866.936.2290 to verify your in-network benefits before starting treatment.
03. What does New York Medicaid cover for addiction treatment?
New York Medicaid covers a comprehensive range of substance use disorder services: medical detox, inpatient and residential treatment at OASAS-licensed facilities, partial hospitalization programs, intensive outpatient programs, standard outpatient therapy, medication-assisted treatment, methadone maintenance through OTPs, and dual diagnosis care. HARP enrollees also receive enhanced Home and Community-Based Services.
05. What is HARP, and am I eligible?
HARP (Health and Recovery Plans) is a special Medicaid Managed Care product for adults age 21+ with significant behavioral health needs. HARP enrollees receive all standard Medicaid benefits plus enhanced Home and Community Based Services (HCBS), including peer support, employment supports, family support, and enhanced care coordination through Health Homes. New York State automatically identifies and enrolls eligible members in HARP, but you can also ask your Medicaid plan or local DSS about HARP enrollment if you have a serious mental health condition or significant SUD.
07. How long will Medicaid cover inpatient addiction treatment?
Under New York State Insurance Law, fully insured plans (including Medicaid Managed Care) must approve up to 28 days of inpatient substance use treatment at a NY State Office of Addiction Services and Supports (OASAS)-licensed facility for members with a primary substance use disorder diagnosis, without prior authorization, provided the facility notifies the plan within two business days of admission. Coverage past 28 days is reviewed using LOCADTR 3.0 based on your progress and ongoing clinical need.
09. Will my employer or family find out I'm seeking treatment?
No. Federal law (HIPAA and 42 CFR Part 2) provides strong confidentiality protections for substance use treatment records, including a special set of additional protections specifically for addiction treatment. Your employer is not notified, and your Medicaid plan cannot share your treatment details with anyone without your written authorization.
02. Do I have to pay anything for addiction treatment with Medicaid?
Most New York Medicaid Managed Care members pay $0 or near-zero copays for substance use disorder treatment. New York Medicaid rules also cap total out-of-pocket costs at $200 per calendar year for both inpatient and outpatient rehab combined. There are no deductibles for Medicaid Managed Care members, and no annual or lifetime limits on medically necessary substance use disorder treatment.
04. How do I know which Medicaid plan I'm enrolled in?
Check your Medicaid Managed Care ID card; it will identify your specific plan (such as Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, or CDPHP). If you have straight Medicaid, you’ll have a benefit card from New York State. You can also confirm your plan and enrollment status by calling NY Medicaid Choice at 1-800-505-5678 or your local Department of Social Services.
06. Does NY Medicaid cover MAT medications like Suboxone, Sublocade, and methadone?
Yes. New York Medicaid covers all FDA-approved medication-assisted treatment medications, including Sublocade and Suboxone (buprenorphine) for opioid use disorder, methadone (provided through OASAS-licensed Opioid Treatment Programs), and naltrexone or Vivitrol for opioid and alcohol use disorders. Under recent New York Insurance Law changes, prior authorization is generally not required for medications used to treat substance use disorder.
08. Do I need a referral from a doctor?
Most Medicaid Managed Care plans don’t require a referral for substance use disorder treatment, but some may have specific authorization requirements. Our admissions team will check the requirements for your specific plan during the verification process.
10. What if Medicaid denies coverage for my treatment?
Don’t give up. New York Medicaid plans have multiple levels of internal appeals, and you also have the right to a Medicaid Fair Hearing through the New York Office of Temporary and Disability Assistance, a separate, independent review process. Our admissions and clinical teams help guide you through internal appeals, and a peer-to-peer review with a plan medical director is often available. You can also file a complaint with the New York State Department of Financial Services at 1-800-400-8882.
01. Is Fusion Recovery in-network with New York Medicaid?
Fusion Recovery may be in-network with New York Medicaid Managed Care plans serving Albany, NY, and the surrounding Capital Region. Network status varies by your specific plan, Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, CDPHP, etc. We recommend calling our admissions team at 1.866.936.2290 to verify your in-network benefits before starting treatment.
02. Do I have to pay anything for addiction treatment with Medicaid?
Most New York Medicaid Managed Care members pay $0 or near-zero copays for substance use disorder treatment. New York Medicaid rules also cap total out-of-pocket costs at $200 per calendar year for both inpatient and outpatient rehab combined. There are no deductibles for Medicaid Managed Care members, and no annual or lifetime limits on medically necessary substance use disorder treatment.
03. What does New York Medicaid cover for addiction treatment?
New York Medicaid covers a comprehensive range of substance use disorder services: medical detox, inpatient and residential treatment at OASAS-licensed facilities, partial hospitalization programs, intensive outpatient programs, standard outpatient therapy, medication-assisted treatment, methadone maintenance through OTPs, and dual diagnosis care. HARP enrollees also receive enhanced Home and Community-Based Services.
04. How do I know which Medicaid plan I'm enrolled in?
Check your Medicaid Managed Care ID card; it will identify your specific plan (such as Fidelis Care, UnitedHealthcare Community Plan, MVP Health Care, or CDPHP). If you have straight Medicaid, you’ll have a benefit card from New York State. You can also confirm your plan and enrollment status by calling NY Medicaid Choice at 1-800-505-5678 or your local Department of Social Services.
05. What is HARP, and am I eligible?
HARP (Health and Recovery Plans) is a special Medicaid Managed Care product for adults age 21+ with significant behavioral health needs. HARP enrollees receive all standard Medicaid benefits plus enhanced Home and Community Based Services (HCBS), including peer support, employment supports, family support, and enhanced care coordination through Health Homes. New York State automatically identifies and enrolls eligible members in HARP, but you can also ask your Medicaid plan or local DSS about HARP enrollment if you have a serious mental health condition or significant SUD.
06. Does NY Medicaid cover MAT medications like Suboxone, Sublocade, and methadone?
Yes. New York Medicaid covers all FDA-approved medication-assisted treatment medications, including Sublocade and Suboxone (buprenorphine) for opioid use disorder, methadone (provided through OASAS-licensed Opioid Treatment Programs), and naltrexone or Vivitrol for opioid and alcohol use disorders. Under recent New York Insurance Law changes, prior authorization is generally not required for medications used to treat substance use disorder.
07. How long will Medicaid cover inpatient addiction treatment?
Under New York State Insurance Law, fully insured plans (including Medicaid Managed Care) must approve up to 28 days of inpatient substance use treatment at a NY State Office of Addiction Services and Supports (OASAS)-licensed facility for members with a primary substance use disorder diagnosis, without prior authorization, provided the facility notifies the plan within two business days of admission. Coverage past 28 days is reviewed using LOCADTR 3.0 based on your progress and ongoing clinical need.
08. Do I need a referral from a doctor?
Most Medicaid Managed Care plans don’t require a referral for substance use disorder treatment, but some may have specific authorization requirements. Our admissions team will check the requirements for your specific plan during the verification process.
09. Will my employer or family find out I'm seeking treatment?
No. Federal law (HIPAA and 42 CFR Part 2) provides strong confidentiality protections for substance use treatment records, including a special set of additional protections specifically for addiction treatment. Your employer is not notified, and your Medicaid plan cannot share your treatment details with anyone without your written authorization.
10. What if Medicaid denies coverage for my treatment?
Don’t give up. New York Medicaid plans have multiple levels of internal appeals, and you also have the right to a Medicaid Fair Hearing through the New York Office of Temporary and Disability Assistance, a separate, independent review process. Our admissions and clinical teams help guide you through internal appeals, and a peer-to-peer review with a plan medical director is often available. You can also file a complaint with the New York State Department of Financial Services at 1-800-400-8882.
Disclaimer: The information provided on this website regarding insurance coverage is only a summary. It does not include all limitations, exclusions, or qualifiers that may apply to your actual coverage. Please refer to your Medicaid Managed Care plan's Member Handbook or the New York State Department of Health's Medicaid Provider Manual for full details. Treatment services must be medically necessary to be covered. Any treatment decisions must be discussed with your health provider. We cannot guarantee any coverage or reimbursement. Please contact your Medicaid plan directly for the most accurate information regarding your benefits.
Take the first step
Providing hope to all. Compassionate outpatient care for our community. Ready to talk?
Recovery begins when you reach out. Questions?
Call anytime to speak with an Admissions
Specialist, or request a consultation and we’ll follow up.
David Sietz, M.D.
Chief Medical Officer, Fusion Recovery
Email us or Call
Contact Form
"(Required)" indicates required fields
Start Healing Today
At Fusion Recovery, we understand the difficulties that addiction can bring into your life. That’s why we offer personalized outpatient addiction treatment tailored to your unique needs. As an outpatient rehab facility, we provide flexible scheduling so you can continue your work, family life, and other commitments while getting the help you deserve.
Fusion Recovery proudly accepts Medicaid coverage for addiction treatment services including outpatient rehab, therapy, medication-assisted treatment, and more. Our compassionate team of experts will verify your Medicaid benefits, take care of claims, and make insurance processes smooth. More importantly, we’ll craft an individualized treatment plan using evidence-based therapies and holistic methods to facilitate your lifelong recovery.
With Fusion Recovery, you can find judgment-free support and healing in a comfortable environment. Our welcoming facility and amenities create a peaceful space for you to focus on your recovery journey. If you or a loved one is struggling with addiction, contact us today to learn more about Medicaid coverage and how we can help you get your life back.
Overview of Medicaid Benefits
Fusion Recovery is in-network with Medicaid plans.
Treatment services covered
Medicaid covers services like outpatient rehab, individual therapy, group therapy, medication management, and aftercare support.
Coverage details
Coverage details vary by individual Medicaid plan. Out-of-pocket costs such as copays, deductibles, and coverage levels depend on your specific benefits. Our team can help verify your coverage and explain your options before starting treatment.
Preauthorization requirements
Prior authorization may be required for medication-assisted treatment and intensive outpatient programs. Fusion Recovery can assist with obtaining authorizations.
CALL NOW
Safe and Effective
Verify Your Insurance Coverage.
Remember, the specifics of coverage can vary based on your individual plan and location. It’s always a good idea to confirm coverage with both your insurance provider and Fusion Recovery.
What We Treat
Alcohol Treatment
Alcohol is widely available, which can make harmful patterns harder to spot early.
Heroin Treatment
Heroin is a fast-acting opioid that can quickly reshape the brain and body.
Fentanyl Treatment
Fentanyl is a potent synthetic opioid linked to high overdose risk, even at small amounts.
Disclaimer: The information provided on this website regarding insurance coverage is only a summary. It does not include all limitations, exclusions, or qualifiers that may apply to your actual coverage. Please refer to your health plan’s Evidence of Coverage or Summary Plan Description for the full details and specifics of your benefits. Treatment services must be medically necessary to be covered by your health plan. Whether a treatment or service is medically necessary will be determined based on a review of clinical information provided by your provider. Any treatment decisions must be discussed and determined in conjunction with your health provider. We cannot guarantee any coverage or reimbursement. Please contact your health plan directly for the most accurate and up-to-date information regarding your benefits and coverage for addiction treatment services.
Take the first step
Providing hope to all. Compassionate outpatient care for our community. Ready to talk?
Recovery begins when you reach out. Questions?
Call anytime to speak with an Admissions
Specialist, or request a consultation and we’ll follow up.
David Sietz, M.D.
Chief Medical Officer, Fusion Recovery
Email us or Call
Contact Form
"(Required)" indicates required fields
