WellCare of Kentucky addiction treatment coverage
WellCare covers the clinical continuum of substance use treatment for substance use disorder. Discuss your coverage with Golden Grove Recovery in Louisville, Kentucky.
What WellCare is
WellCare of Kentucky is a Centene Corporation Medicaid managed care plan serving Kentucky Medicaid members statewide. WellCare covers the full continuum of substance use disorder treatment — from medical detox through outpatient MAT — with a focus on integrated behavioral health for members with co-occurring mental health conditions.
What WellCare covers for SUD treatment
- Residential SUD treatment (ASAM 3.1, 3.3, 3.5) based on ASAM medical-necessity criteria
- PHP (ASAM 2.5) and IOP (ASAM 2.1) as step-down or step-up levels
- Outpatient SUD counseling — individual, group, and family
- Medication-Assisted Treatment — Suboxone, methadone, Vivitrol, oral naltrexone
- Dual-diagnosis and integrated behavioral health services
- Peer support and recovery coaching as a covered Medicaid benefit
- Non-emergency medical transportation (NEMT) for treatment visits
Levels of care WellCare 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 WellCare
WellCare covers the following FDA-approved medications for opioid and alcohol use disorder:
SuboxoneMethadoneVivitrolOral Naltrexone
Read more about how Medicaid covers MAT, including authorization and pharmacy benefits.
How prior auth works with WellCare
WellCare of Kentucky typically applies ASAM criteria for medical-necessity determinations. Residential SUD admissions generally require prior authorization; outpatient services, PHP, and IOP may be handled through notification and concurrent review.
Member benefits that apply to SUD
WellCare members have access to a 24/7 nurse advice line, care management for complex SUD and dual-diagnosis needs, and Centene's integrated behavioral health network.
More on WellCare at https://www.wellcareky.com/.
Talk to admissions about WellCare coverage
Call us or send a message — we'll discuss what your WellCare plan covers and the next step.
Frequently asked questions
Does WellCare cover residential addiction treatment?
Yes. WellCare 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 WellCare cover Suboxone or methadone?
WellCare covers Suboxone, Methadone, Vivitrol, Oral Naltrexone as part of its MAT benefit. Methadone is delivered through licensed opioid treatment programs (OTPs).
Will WellCare 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 WellCare?
WellCare of Kentucky typically applies ASAM criteria for medical-necessity determinations. Residential SUD admissions generally require prior authorization; outpatient services, PHP, and IOP may be handled through notification and concurrent review.
Is Golden Grove Recovery in-network with WellCare?
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.