Medicaid in Ohio: Plan Types and Coverage for Drug Rehab and Mental Health

Ohio Medicaid covers 3.21 million residents representing 27% of the state’s population, with behavioral health services receiving over $1 billion in federal funding during 2024 (USAFacts, 2024; HPIO, 2025). The program operates primarily through managed care plans serving 90% of enrollees, where CareSource functions as the largest Medicaid managed care provider with over 2.1 million members across Ohio markets (Community Solutions, 2019; CareSource, 2023). Among the 770,000 Ohio residents enrolled through ACA Medicaid expansion, 40% carry primary mental health or substance use disorder diagnoses, making Medicaid the dominant payer for 60% of substance abuse treatment admissions compared to private insurance covering only 15% of cases (HPIO, 2025; SAMHSA, 2020). Coverage integration occurred in July 2018 when Ohio carved behavioral health services into managed care, extending federal parity protections under the Mental Health Parity and Addiction Equity Act to 2.6 million Medicaid participants, though significant access barriers persist with patients 5 times more likely to seek out-of-network behavioral health care due to provider shortages and reimbursement rates averaging 22% lower for mental health clinicians, contributing to Ohio’s “F” grade in national mental health parity performance assessments (Community Solutions, 2019; NAMI/RTI, 2024; Ohio Senate, 2020).

What is Ohio Medicaid and How Does It Cover Mental Health Services?

Ohio Medicaid is a joint federal-state healthcare program covering 3.21 million residents, representing 27% of Ohio’s population (USAFacts, 2024). The program’s enrollment declined 9.9% from its 2023 peak due to eligibility redeterminations (USAFacts, 2024). Behavioral health services were integrated into Medicaid managed care in July 2018, extending mental health parity protections to 2.6 million enrollees (Community Solutions, 2019). This integration ensures mental health and substance use disorder treatments receive equivalent coverage to medical services.

Approximately 90% of Ohio Medicaid enrollees participate in managed care plans that comply with federal parity requirements (Community Solutions, 2019). These managed care organizations cover mental health and substance use disorder services equivalently to medical care under federal law. CareSource, Ohio’s largest Medicaid managed care plan, serves over 2.1 million members across its markets (CareSource, 2023). The Mental Health Parity and Addiction Equity Act requires insurance plans impose no stricter cost-sharing or treatment limits on behavioral health benefits than medical benefits (CMS, 2023).

Ohio’s Medicaid expansion group includes approximately 770,000 residents as of 2025 (HPIO, 2025). In 2024, 40% of Ohio’s Medicaid expansion enrollees had primary mental health or substance use disorder diagnoses (HPIO, 2025). Over $1 billion in federal funds supported mental health and addiction services for Ohio’s Medicaid expansion enrollees in calendar year 2024 (HPIO, 2025). Medicaid serves as the primary payment source for 60% of Ohio’s substance abuse treatment admissions, while private insurance covers roughly 15% of treatment cases (SAMHSA, 2020).

Which Types of Medicaid Plans Are Available in Ohio?

Ohio offers 2 primary types of Medicaid plans through its managed care system, which covers 90% of the state’s 3.21 million Medicaid enrollees (Community Solutions, 2019). CareSource, a Dayton-based nonprofit insurer, dominates Ohio’s Medicaid managed care market by serving over 2.1 million members across its coverage areas (CareSource, 2023). These managed care plans operate under federal parity requirements that mandate comprehensive mental health and substance use disorder coverage equivalent to medical services.

In 2023, Ohio implemented “Next Generation” Medicaid managed care plans designed to improve care coordination and enhance behavioral health support services (ODM, 2023). These modernized plans include specialized children’s behavioral health plans that address the unique mental health needs of pediatric populations. The Next Generation system builds upon Ohio’s 2018 integration of behavioral health services into Medicaid managed care, which extended parity protections to approximately 2.6 million Medicaid enrollees (Community Solutions, 2019).

All Ohio Medicaid managed care plans must comply with federal parity laws requiring equal coverage limits and cost-sharing for mental health and substance use disorder services compared to medical benefits (Community Solutions, 2019). These plans cover all 3 FDA-approved medications for opioid use disorder including buprenorphine, methadone, and naltrexone without prior authorization requirements (ODM, 2021). Medicaid serves as the primary payment source for approximately 60% of Ohio’s substance abuse treatment admissions, while self-pay admissions dropped to under 10% following expansion (SAMHSA, 2020).

How Does Ohio Medicaid Expansion Affect Drug Rehab and Mental Health Coverage?

Ohio Medicaid expansion dramatically increases drug rehabilitation and mental health coverage access for 770,000 residents enrolled through ACA expansion programs (HPIO, 2025). Expansion enrollees with primary mental health or substance use disorder diagnoses comprise 40% of total enrollment, representing over 300,000 Ohioans receiving behavioral health coverage (HPIO, 2025). Federal funding allocated over $1 billion for mental health and addiction services specifically for Ohio’s Medicaid expansion enrollees during 2024 (HPIO, 2025). This expanded coverage creates critical access pathways for drug treatment and psychiatric services previously unavailable to uninsured populations.

Medicaid expansion transforms substance abuse treatment accessibility by reducing financial barriers to rehab services. Uninsured self-pay admissions for substance abuse treatment plummeted from 43,136 admissions in 2008 to just 9,979 in 2018 following expansion implementation (SAMHSA, 2020). Medicaid became the primary payment source for 60% of Ohio’s substance abuse treatment admissions by 2018, while uninsured admissions dropped to under 10% of total cases (SAMHSA, 2020). Ohio’s Medicaid program covers all three FDA-approved medications for opioid use disorder including buprenorphine, methadone, and naltrexone without prior authorization requirements (ODM, 2021).

Expansion coverage proves essential for Ohio’s opioid crisis response by providing treatment access to 96,000 Ohioans with opioid use disorder who gained coverage through expansion (HPIO, 2025). States expanding Medicaid, including Ohio, experienced slower growth in opioid overdose mortality compared to non-expansion states during the 2014-2017 period (JAMA, 2020). Medicaid expansion associates with reduced opioid overdose death rates, particularly for heroin and synthetic opioids like fentanyl which now accounts for over 80% of Ohio’s overdose deaths (ODH, 2023). Parity requirements ensure Medicaid managed care plans apply equivalent coverage standards for mental health and substance use disorder services as medical-surgical benefits (Community Solutions, 2019).

What Drug Rehab Services Does Ohio Medicaid Cover?

Ohio Medicaid covers comprehensive substance use disorder treatment services including behavioral counseling, residential rehabilitation programs, and all FDA-approved addiction medications under ACA essential health benefit requirements (HHS, 2022). The state’s Medicaid program provides coverage for all three FDA-approved medications for opioid use disorder – buprenorphine, methadone, and naltrexone – without prior authorization barriers, following federal mandates implemented in 2020 (ODM, 2020). By 2018, Medicaid became the primary payment source for the majority of Ohio’s substance abuse treatment admissions, while uninsured self-pay cases dropped from 43,136 admissions in 2008 to just 9,979 in 2018 (SAMHSA, 2020). Nearly 75% of Medicaid enrollees with diagnosed substance use disorders accessed treatment services in 2020 (KFF, 2023).

Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending parity protections to approximately 2.6 million Medicaid enrollees and requiring equivalent coverage for addiction treatment and medical services (Community Solutions, 2019). About 90% of Ohio Medicaid participants are enrolled in managed care plans, ensuring parity requirements apply to the vast majority of recipients needing substance abuse interventions (Community Solutions, 2019). Medicaid coverage includes inpatient detoxification, outpatient counseling, medication-assisted treatment, and residential rehabilitation facilities. In 2024, 40% of Ohio’s Medicaid expansion enrollees had primary mental health or substance use disorder diagnoses, with over $1 billion in federal funds supporting these services (HPIO, 2025).

Drug rehabilitation services covered under Ohio Medicaid encompass intensive outpatient programs, partial hospitalization, peer recovery support, and family counseling components. The state removed administrative barriers for opioid addiction medications, eliminating dosage restrictions and streamlining access to buprenorphine/naloxone combination therapies (ODI, 2023). Medicaid enrollees with substance use disorders generate approximately $1,200 per member monthly healthcare costs compared to $550 for those without addiction diagnoses, reflecting comprehensive service utilization (KFF, 2023). An estimated 96,000 Ohioans with opioid use disorder gained treatment coverage through Medicaid expansion, making continued program funding crucial for the state’s overdose crisis response (HPIO, 2025).

What Mental Health Services Are Covered Under Ohio Medicaid?

Mental health services covered under Ohio Medicaid include comprehensive behavioral health treatments, therapy sessions, psychiatric services, and inpatient mental health treatment, classified as one of ten essential health benefit categories under the ACA (CMS, 2023). Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending parity protections to approximately 2.6 million Medicaid enrollees (Community Solutions, 2019). The Mental Health Parity and Addiction Equity Act requires insurance plans impose no stricter cost-sharing or treatment limits on mental health benefits than on medical/surgical benefits (CMS, 2023). About 90% of Ohio Medicaid enrollees are in managed care, ensuring parity requirements apply to the vast majority of recipients with behavioral health needs (Community Solutions, 2019).

Ohio’s Medicaid program covers all three FDA-approved medications for opioid use disorder including buprenorphine, methadone, and naltrexone (ODM, 2021). In 2024, 40% of Ohio’s Medicaid expansion enrollees had a primary mental health or substance use disorder diagnosis (HPIO, 2025). Medicaid plans have removed prior authorization requirements for medication-assisted treatment for opioid use disorder, aligning with federal mandates (ODM, 2020). Over $1 billion in federal funds were used for mental health and addiction services for Ohio’s Medicaid expansion enrollees in calendar year 2024 (HPIO, 2025).

Insurers’ spending on behavioral health claims has risen significantly, with $122.79 average payment per behavioral health claim in 2023, up from $106.84 in 2018 (PwC, 2023). Behavioral health services accounted for 3.8% of all medical claim costs in 2023, more than double their 1.8% share in 2018 (PwC, 2023). Nearly 3 in 4 Medicaid enrollees with a diagnosed substance use disorder used some substance use treatment or support services in 2020 (KFF, 2023). Among Medicaid enrollees with opioid use disorder, 63% received medication-assisted treatment in 2020, compared to only 10% of those with alcohol use disorder receiving medication therapy (KFF, 2023).

How Do Federal Parity Laws Affect Ohio Medicaid Coverage?

Federal parity laws require Ohio Medicaid plans to provide equal cost-sharing and treatment limits for mental health and substance use disorder benefits compared to medical and surgical benefits under MHPAEA (CMS, 2023). Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending parity protections to approximately 2.6 million Medicaid enrollees (Community Solutions, 2019). Currently, about 90% of Ohio Medicaid enrollees are in managed care plans, meaning parity requirements apply to the vast majority of recipients with behavioral health needs (Community Solutions, 2019). Ohio’s outdated 2006 parity law remains narrower than federal requirements and has not been updated to align with MHPAEA standards (Ohio Senate, 2020).

Ohio received an “F” grade in national mental health parity performance assessments due to its outdated parity statutes that conflict with federal requirements (Ohio Senate, 2020). As of 2019, Ohio laws still allowed more restrictive limits on mental health and substance use disorder benefits than on physical healthcare, creating ongoing conflicts between state and federal parity provisions (Community Solutions, 2019). Ohio patients needing behavioral health services have been up to 5 times more likely to go out-of-network for care than patients with other medical needs (Community Solutions, 2019). Federal audits in 2022 found numerous parity violations by insurers nationwide, including more frequent denials for inpatient SUD rehabilitation than for medical hospital stays (DOL, 2022).

In March 2025, federal regulators proposed new rules to strengthen enforcement of mental health parity, aiming to hold insurers accountable for unequal coverage (WHIO, 2025). The U.S. Department of Labor took action in 2022 against health plans that failed parity tests, pushing insurers including some in Ohio to remove unequal treatment limitations (DOL, 2022). Among Ohio’s 3.21 million Medicaid enrollees in 2024, approximately 40% of Medicaid expansion enrollees had a primary mental health or substance use disorder diagnosis (USAFacts, 2024; HPIO, 2025). Over $1 billion in federal funds were used for mental health and addiction services for Ohio’s Medicaid expansion enrollees in calendar year 2024 (HPIO, 2025).

What Network Access Issues Exist for Behavioral Health in Ohio?

Ohio patients requiring behavioral health treatment are up to 5× more likely to seek out-of-network providers compared to those needing standard medical care (Community Solutions, 2019). This network access disparity aligns with national trends showing out-of-network utilization rates are 3.5× higher for mental health and substance use disorder services than medical-surgical treatments (NAMI/RTI, 2024). Mental health clinicians receive 22% lower in-network reimbursement rates compared to other medical practitioners, creating significant barriers to provider network participation (NAMI/RTI, 2024).

Provider reimbursement disparities force many Ohioans to access higher-cost out-of-network behavioral health services despite existing parity legislation. NAMI reports persistent difficulties for Ohio residents attempting to locate affordable in-network therapists and psychiatrists (NAMI, 2024). Ohio’s state parity law remains narrower than federal requirements and has not been updated to align with the Mental Health Parity and Addiction Equity Act (Ohio Senate, 2020). These outdated parity statutes contributed to Ohio receiving an “F” grade in one national mental health parity performance assessment (Ohio Senate, 2020).

Network adequacy problems persist across Ohio’s insurance markets, with 90% of Medicaid enrollees in managed care plans that must comply with parity requirements since behavioral health integration in 2018 (Community Solutions, 2019). The majority of individual market plans in Ohio operate as HMO or EPO structures, providing no coverage for out-of-network non-emergency care (ODI, 2023). Federal audits in 2022 identified numerous parity violations by insurers nationwide, including more frequent denials for inpatient substance use disorder rehabilitation compared to medical hospital admissions (DOL, 2022).

How Do Ohio Marketplace Plans Compare to Medicaid for Behavioral Health Coverage?

Ohio Marketplace plans provide mandatory behavioral health coverage but face significant network limitations compared to Medicaid’s comprehensive approach. The 477,793 Ohioans enrolled in 2024 ACA Marketplace plans represent a 62% increase from 294,644 in 2023, with all plans required to include mental health and substance use disorder services as essential benefits (CMS, 2024). While 13 insurers offered Marketplace plans in 2025, the majority are HMO or EPO types with no out-of-network coverage, making provider access critical (HealthInsurance.org, 2024). Marketplace enrollees face high-deductible plans creating affordability barriers, while Ohio’s 3.21 million Medicaid recipients access more comprehensive behavioral health services with lower cost-sharing requirements (USAFacts, 2024).

Cost differences between Ohio Marketplace plans and Medicaid create distinct access patterns for mental health treatment. Marketplace plans impose $1,735 average annual deductibles for single coverage, with maximum out-of-pocket limits reaching $9,450 for individual plans in 2024 (KFF, 2023; CMS, 2023). Medicaid expansion enrollees receive substantially different treatment access, with 40% having primary mental health or substance use disorder diagnoses and over $1 billion in federal funds supporting their behavioral health services in 2024 (HPIO, 2025). Network adequacy remains problematic across both systems, as Ohio patients needing behavioral health services are up to 5× more likely to seek out-of-network care compared to other medical needs (Community Solutions, 2019).

Provider reimbursement disparities significantly impact network participation across Ohio insurance plans. In-network reimbursement for mental health clinicians averages 22% lower than other medical providers, creating persistent network gaps that force patients toward higher-cost out-of-network care (NAMI/RTI, 2024). Ohio’s Medicaid managed care system covers 90% of enrollees with parity protections since 2018, while commercial insurers continue facing federal enforcement actions for unequal treatment limitations (Community Solutions, 2019; DOL, 2022). Medicaid pays for 60% of Ohio’s substance abuse treatment admissions, compared to private insurance covering only 15% of treatment cases, demonstrating Medicaid’s dominant role in addiction recovery services (SAMHSA, 2020).

What Are the Current Challenges in Ohio’s Behavioral Health Coverage?

Ohio’s behavioral health coverage faces 5 major systemic challenges that compromise patient access and treatment outcomes (Community Solutions, 2019). Network adequacy problems persist as Ohio patients are 5 times more likely to seek out-of-network care for behavioral health services compared to medical needs (Community Solutions, 2019). Reimbursement disparities create provider shortages, with mental health clinicians receiving 22% lower payments than other medical specialists (NAMI/RTI, 2024). Out-of-network behavioral health utilization remains 3.5 times higher nationally than medical care usage (NAMI/RTI, 2024).

Federal parity violations continue plaguing Ohio’s health insurance landscape despite regulatory requirements. The Department of Labor identified numerous compliance failures during 2022 audits, including more frequent denials for inpatient substance use disorder rehabilitation than medical hospitalizations (DOL, 2022). Enforcement actions targeted Ohio health plans that failed parity assessments, forcing insurers to eliminate unequal treatment restrictions and coverage limitations (DOL, 2022). Ohio received an “F” grade in national mental health parity performance due to outdated state laws conflicting with federal requirements (Ohio Senate, 2020).

Contract disputes between major insurers and healthcare systems threaten coverage stability for hundreds of thousands of Ohioans. The late-2024 Anthem-OhioHealth disagreement jeopardized in-network access for over 100,000 patients before resolution in 2025 (WOSU, 2025). Behavioral health claims costs increased dramatically, with insurers paying an average of $122.79 per claim in 2023 compared to $106.84 in 2018 (PwC, 2023). Mental health and substance use services now represent 3.8% of total medical costs, doubling from 1.8% in 2018 (PwC, 2023).

How Do Treatment Disparities Affect Different Populations in Ohio Medicaid?

Treatment disparities create significant access barriers for vulnerable populations within Ohio’s Medicaid system, with 4 in 10 Black enrollees with opioid use disorder receiving medication treatment versus nearly 7 in 10 White enrollees (KFF, 2023). Racial inequities persist despite Ohio integrating behavioral health services into Medicaid managed care in July 2018, extending parity protections to 2.6 million Medicaid enrollees (Community Solutions, 2019). Age-based treatment gaps demonstrate equally concerning patterns, with only 12% of Medicaid-enrolled youth with OUD receiving medication treatment compared to 63% of adults ages 27-44 (KFF, 2023).

Medication-assisted treatment access varies dramatically across demographic groups, highlighting systemic barriers to equitable care delivery. Among Ohio’s 3.21 million Medicaid enrollees in 2024, approximately 18% had undiagnosed substance use disorders when including those not formally identified through clinical assessment (KFF, 2023). Youth treatment participation remains critically low despite Ohio removing prior authorization requirements for opioid use disorder medications in line with federal mandates (ODM, 2020). Treatment participation rates differ by up to 50 percentage points between states, indicating significant variation in Medicaid substance use disorder service implementation (KFF, 2023).

Healthcare spending patterns reflect the complexity of treating substance use disorders across different populations within Ohio’s Medicaid system. Medicaid enrollees with substance use disorders incur 2× the healthcare spending of those without SUD, averaging $1,200 versus $550 per member per month (KFF, 2023). Ohio’s Medicaid expansion population includes 96,000 Ohioans with opioid use disorder who gained coverage through expansion, representing a critical population requiring equitable treatment access (HPIO, 2025). Fentanyl involvement in over 80% of Ohio’s overdose deaths underscores the urgent need for eliminating treatment disparities across all demographic groups (ODH, 2023).