Health Plan Of San Joaquin Rehab Coverage

Health Plan of San Joaquin provides insurance to many residents of San Joaquin and Stanislaus counties in California. Besides preventive care, HPSJ also offers coverage for mental health and substance use treatment, when patients qualify. Read on to learn more.

Many people shy away from getting the help they need for a substance use disorder because the cost of treatment can be expensive. Fortunately, many insurance companies offer plans which help cover the cost of addiction and substance use disorder treatment programs.

One of these companies is Health Plan of San Joaquin (HPSJ). HPSJ is the top Medi-Cal (California’s Medicaid program) managed plan for San Joaquin and Stanislaus counties. HPSJ serves more than one in four Stanislaus county residents and three of every 10 San Joaquin County residents.

HPSJ plans not only cover wellness and preventive services but also behavioral health care, including treatment for mental health and substance use disorder.

Some of their plans might even cover the full cost of treatment. However, it is best to speak with one of their representatives about coverage before checking into a treatment program.

Affordable Care Act

The Affordable Care Act (aka Obamacare) has made substance use disorder and mental health services into essential benefits, so everyone should have coverage. Depending on the plan someone has will determine what their deductibles may be, as well as which facilities they can be treated.

It’s always a good idea to check with your insurance provider to find out what is covered, where you can go, and what the costs will be.

Levels of Care

Health Plan of San Joaquin is the top Medi-Cal provider for San Joaquin and Stanislaus counties. Medi-Cal is California’s Medicaid program. To qualify for Medi-Cal a person must be any of the following:

  • Have an income 138% below the federal poverty level
  • Age 65 or older
  • Disabled
  • Under the age of 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • A foster child

Medicaid plans do include mental health and substance use disorder coverage, but not every rehab center accepts Medicaid patients. For that reason, it’s a good idea to confirm coverage and get prior authorization for treatment.

Drug and Alcohol Rehab

Does Health Plan of San Joaquin cover drug and alcohol rehab? Like most plans available through the Marketplace or via Medicaid, addiction treatment is covered. That can include detox, inpatient hospitalization, and counseling. Medications may be needed to manage conditions, too.

Health Plan of San Joaquin works with Beacon Health Strategies, Medi-Cal managed care plans, and county mental health plans to provide mental health and substance use disorder treatment.

In many cases, the company will help pay for drug and alcohol detoxification treatment. It’s a good idea to speak to a representative first to find out what is covered, where you can get treatment, and make sure you have prior approval. You may also have to meet a deductible before insurance begins paying.

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Length of Treatment

The length of treatment Health Plan of San Joaquin permits can vary. The National Institute of Drug Abuse suggests considering a patient’s whole story when deciding on treatment. That includes what substances they are dependent on, for how long, how frequently they are used, and any other co-occurring health issues.

Both addiction behaviors and any psychological issues ideally should be addressed at the same time. So should the patient’s age, gender, ethnicity, culture, and other factors.

A longer treatment stay — three months, at least — usually leads to better results.

Some insurance companies prefer to approve a shorter stay at first (30 days is normal) so rehabs will sometimes work with them to try and seek more treatment time for the patient if needed.

Mental Health

Does Health Plan of San Joaquin also cover mental health? The ACA says mental health care is an essential service, so HPSJ will offer some mental health treatment options. HPSJ does work with Beach Health Strategies to link people to mental health services. These can include group and individual therapies, psychiatric consultations, psychological testing, and behavioral health treatment. Medi-Cal managed care plans and county mental health plans also have options for mental health and substance use treatment.

Inpatient Rehab

Health Plan of San Joaquin inpatient rehab would involve the patient checking into a facility and staying onsite, often for 30 days, and sometimes longer. There, they’ll get care for their substance use disorder and any co-occurring mental health issues. Inpatient rehab usually happens in stages:

  • Assessment. Staff examines the patient so they can shape a treatment plan.
  • Detoxification. Many patients undergo detox, where the body rids itself of drugs when they first enter rehab. Sometimes medication is administered to keep the withdrawal symptoms more manageable. Sometimes medication keeps the patient safe, since going cold turkey can be dangerous for some substances.
  • Treatment. Behavioral therapies (like cognitive-behavioral therapy) and counseling are common during this stage. The goal is to help the patient learn what led to and contributed to their addiction as well as learn ways to cope with stress and triggers without relapsing.
  • Aftercare. Here, the patient is prepared for life after rehab, usually with plans to check back in at the rehab for progress updates or to receive counseling or attend group therapies closer to home.

The above stages are generally what a person can expect out of inpatient rehab. The specifics will vary from facility to facility. Costs will vary, too. To save money, it’s a good idea to get prior authorization and seek care from a place that’s in-network.

Outpatient Services

Health Plan of San Joaquin outpatient services can serve as an alternative to inpatient care, but also as an extension of it.

If a patient gets intensive outpatient treatment they will probably visit the rehab several times a week, for several hours at a time, to get therapy and counseling, and build on strengthening their abstinence.

Outpatient care can also include visits to a therapist or counselor to work on any challenges a patient may face.

Suboxone Treatment

Suboxone is the brand name for two drugs, buprenorphine, and naloxone. Suboxone is used for medication-assisted treatment (MAT), a combination of counseling, behavioral therapies, and medicine to treat addiction.

The combination of buprenorphine and naloxone can help treat opioid use disorder. By producing some of the effects of opioids, but with a less intense high, can help some people through withdrawal and cravings and sometimes prevent relapse.

Does Health Plan of San Joaquin cover suboxone treatment? Suboxone, because it’s the brand name, is rarely covered by plans, but often buprenorphine-naloxone will be. Prior authorization might be needed, and there may be daily limits.

Methadone Treatment

Methadone is also used as part of medication-assisted treatment (MAT), having been found to help people with opioid use disorders. Counseling or therapy is recommended along with methadone treatment, as it can help people better manage cravings.

Methadone is an opioid, but its effects are not so sharp and intense so it lasts longer and users won’t feel such a shock by it wearing off rapidly. That can help with cravings and prevent relapse.

Does Health Plan of San Joaquin cover methadone treatment? Methadone is one of the approved drugs on HPSJ’s formulary. (It’s the generic version of Methadose and Dolophine.) Not all formulations may be approved, and daily dosages tend to be limited, but it is covered.

Paying for Rehab

Addiction rehab is rarely cheap, especially since it often includes inpatient care and hospitalization. The cost can make some people steer away from even considering treatment.

Depending on the insurance you have, however, that can make the expense more manageable. Usually, people must meet the deductible and sometimes coinsurance. (In Medi-Cal cases, a person may only need to meet a deductible, which can vary by their income and other circumstances.)

Going in-network and getting care pre-authorized can keep costs down. Knowing deductibles, copays, and coinsurance amounts are also good to know. Insurance providers can offer a lot of answers about what you’ll be responsible for out of pocket. Rehabs can answer a lot of questions about costs and services, too.

When it comes to paying for services not offered by Health Plan of San Joaquin, there are ways to make it easier to manage. Some rehabs can set up a monthly billing plan. Financing can sometimes be arranged, too.


Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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