Medicaid Behavioral Health Services: Methadone for Medication Assisted Treatment (MAT)

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2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 43; No - 2; NR - 6	Yes - 8	Yes - 7
Alabama	Yes	Yes - not specified	No
Alaska	Yes	NR	NR
Arizona	Yes	NR	No
Arkansas	NR	NR	NR
California	Yes	No	No
Colorado	Yes	$3	No
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	Limited to 1 dose/unit per day; an initial and second authorization cover a period of 90 days each; subsequent authorizations cannot exceed 180 days each; maximum number of doses allowed in a 12 month period is 250; anything over these limits require prior authorization based on medical necessity
Florida	Yes	$2	No
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	Yes	No	NR
Indiana	Yes	No	NR
Iowa	Yes	No	No
Kansas	Yes	No	No
Kentucky	Yes	No	NR
Louisiana	Yes	Yes - not specified	NR
Maine	Yes	Up to $2 per week	No
Maryland	Yes	$1 for generic and $3 for brand name, If the drug is administered as a part of a larger visit, there's no cost sharing	No
Massachusetts	Yes	No	One dose per day
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	Yes	NR	Prior authorization is required when provided in an opioid treatment program as a weekly bundled code including medication
Missouri	Yes	No	No
Montana	Yes	No	No
Nebraska	No
Nevada	Yes	No	Prior authorization is required (non-preferred agent) but can be overridden when prescribed for treatment of detoxification/withdrawal
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	No	NR
North Dakota	Yes	No	No
Ohio	Yes	No	Yes - not specified
Oklahoma	Yes	No	NR
Oregon	Yes	No	No
Pennsylvania	Yes	No	No
Rhode Island	Yes	No	No
South Carolina	Yes	No	NR
South Dakota	Yes	$1 pharmacy copay for generic and $3.30 for brand-name	No
Tennessee	Yes	No	No
Texas	Yes	No	If provided in an outpatient setting, limit of once per date of service by any provider; for take-home doses, limit of a quantity of 30 per 30 days by any provider
Utah	NR	NR	NR
Vermont	Yes	NR	NR
Virginia	Yes	No	No
Washington	Yes	No	No
West Virginia	Yes	No	Based on medical necessity
Wisconsin	Yes	$1 generic, $3 brand for drugs billed under the pharmacy benefit	NR
Wyoming	No

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 41 No - 10 NR - 0	Yes - 8	Yes - 15
Alabama	Yes	No	Limit one treatment per day
Alaska	Yes	NR	Covered when provided by opioid treatment programs (OTPs), but only available in Fairbanks or Anchorage
Arizona	Yes	No	No
Arkansas	No
California	Yes	No	No
Colorado	Yes	No	No
Connecticut	Yes	No	Methadone Maintenance requires PA -Methadone Maintenance Clinics reimbursed a daily rate.
Delaware	Yes	No	Prior approval with specific treatment plan
District of Columbia	Yes	$1.00/Rx for point of sale drugs only	No
Florida	Yes	NR	NR
Georgia	Yes	$.50 to $3.00	No
Hawaii	Yes	No	No
Idaho	No
Illinois	Yes	NR	NR
Indiana	Yes	No	NR
Iowa	Yes	NR	NR
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	Up to $2 per week	24 months/lifetime. However, services may be provided beyond 24 months with prior authorization
Maryland	Yes	$1 for generic and preferred brand name drugs; $3 for other brand name drugs	Services are pre-authorized
Massachusetts	Yes	No	No
Michigan	Yes	No	No
Minnesota	Yes	No	NR
Mississippi	Yes	$3 Copay (excludes EPSDT, LTC and pregnant women)	Requires Prior Authorization, Quantity Limits, 2 Brand/5 prescription per month limit
Missouri	Yes	NR	NR
Montana	Yes	No	No
Nebraska	No
Nevada	Yes	No	No
New Hampshire	Yes	No	No
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	NR	NR
North Carolina	Yes	No	NR
North Dakota	No
Ohio	Yes	No	Methadone used for MAT can only be prescribed and dispensed by Opioid Treatment Programs licensed by the Ohio Department of Mental Health and Addiction Services or providers who meet the SAMHSA and DEA criteria for handling controlled substances and have a terminal distributor license through the Ohio Board of Pharmacy. Outside OTPs Ohio Medicaid only covers methadone for use in controlling pain.
Oklahoma	Yes	6 per month limit, up to 2 brand-name; $4 copay for each prescription.	Scope and utilization controls.
Oregon	Yes	No	No
Pennsylvania	Yes	No	Medical necessity
Rhode Island	Yes	No	No
South Carolina	No	NR	NR
South Dakota	Yes	NR	NR
Tennessee	No
Texas	Yes	No	Only available at an opioid treatment program; limited to 30 take home doses per month
Utah	Yes	$4 for each prescription	Methadone clinics provide this service. At POS, only provided for cancer pain.
Vermont	Yes	No	Methadone for Medication-Assisted Treatment is only available through Methadone Treatment Centers. It is not covered through the Medicaid outpatient pharmacy benefit.
Virginia	Yes	No	No
Washington	Yes	No	Prior authorization required
West Virginia	Yes	No	No
Wisconsin	Yes	Generic status of uncompounded products: $1.00, Brand status: $3.00, Maximum copayment of $12.00 per member, per provider, per calendar month.	Restricted by diagnosis
Wyoming	No

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Medicaid Behavioral Health Services: Methadone for Medication Assisted Treatment (MAT)

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Medicaid Behavioral Health Services: Methadone for Medication Assisted Treatment (MAT)

2022

2018

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