Anthem Blue Cross Blue Shield Medicaid addiction treatment coverage
Anthem Medicaid covers the clinical continuum of substance use treatment for substance use disorder. Discuss your coverage with Golden Grove Recovery in Louisville, Kentucky.
What Anthem Medicaid is
Anthem Blue Cross Blue Shield Medicaid is one of Kentucky's managed care organizations, covering Medicaid members across the state with a broad behavioral health and substance use disorder (SUD) benefit. Anthem's Kentucky Medicaid plan covers the clinical continuum of substance use treatment for SUD treatment, including detox, residential, PHP, IOP, outpatient, and medication-assisted treatment.
What Anthem Medicaid covers for SUD treatment
- Residential and inpatient SUD treatment (ASAM 3.1, 3.3, 3.5)
- Partial Hospitalization (PHP) and Intensive Outpatient (IOP)
- Standard outpatient SUD counseling with no arbitrary visit limits
- Medication-Assisted Treatment — including Suboxone, methadone, and Vivitrol
- Integrated treatment for co-occurring mental health conditions (dual diagnosis)
- Coordinated care for pregnant members with SUD via Kentucky's expanded maternal benefit
Levels of care Anthem Medicaid covers
| ASAM | Description |
|---|---|
| 1 | Outpatient (ASAM 1) |
| 2.1 | Intensive Outpatient (ASAM 2.1) |
| 2.5 | Partial Hospitalization (ASAM 2.5) |
| 3.1 | Clinically Managed Low-Intensity Residential (ASAM 3.1) |
| 3.3 | Clinically Managed Population-Specific High-Intensity Residential (ASAM 3.3) |
| 3.5 | Clinically Managed High-Intensity Residential (ASAM 3.5) |
MAT covered by Anthem Medicaid
Anthem Medicaid covers the following FDA-approved medications for opioid and alcohol use disorder:
SuboxoneSubutexMethadoneVivitrolOral Naltrexone
Read more about how Medicaid covers MAT, including authorization and pharmacy benefits.
How prior auth works with Anthem Medicaid
Residential SUD admissions and some MAT induction scenarios typically require prior authorization or concurrent review. Anthem generally applies ASAM criteria for medical-necessity determinations.
Member benefits that apply to SUD
Anthem Medicaid members have access to 24/7 nurse line support, case management for high-risk SUD cases, and non-emergency medical transportation (NEMT) to treatment appointments.
More on Anthem Medicaid at https://www.anthem.com/ky/medicaid.
Talk to admissions about Anthem Medicaid coverage
Call us or send a message — we'll discuss what your Anthem Medicaid plan covers and the next step.
Frequently asked questions
Does Anthem Medicaid cover residential addiction treatment?
Yes. Anthem Medicaid covers residential SUD treatment (ASAM 3.1, 3.3, 3.5) based on medical-necessity determination using ASAM criteria. Prior authorization with concurrent review is typical.
Does Anthem Medicaid cover Suboxone or methadone?
Anthem Medicaid covers Suboxone, Subutex, Methadone, Vivitrol, Oral Naltrexone as part of its MAT benefit. Methadone is delivered through licensed opioid treatment programs (OTPs).
Will Anthem Medicaid cover medical detox?
Kentucky Medicaid plans cover medical withdrawal management when medically necessary, with coverage details that vary by level of care and setting. If detox is part of your situation, talk to our admissions team about the right path for you.
What does prior authorization look like with Anthem Medicaid?
Residential SUD admissions and some MAT induction scenarios typically require prior authorization or concurrent review. Anthem generally applies ASAM criteria for medical-necessity determinations.
Is Golden Grove Recovery in-network with Anthem Medicaid?
Golden Grove Recovery is in pre-opening setup. The information on this page is provided to help you understand Kentucky Medicaid coverage for substance use treatment. Contact our admissions team to discuss your individual situation and treatment options.