Medicaid Substance Use Disorder (SUD) Benefit

The 2009 Texas Legislature authorized HHSC to implement a substance use disorder benefit for adults in Medicaid.  In conjunction with this, HHSC also expanded the existing substance use disorder coverage for children. 

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Overview of Benefit

The comprehensive Medicaid substance use disorder treatment services include outpatient services (assessment, ambulatory (outpatient) detoxification, individual and group outpatient counseling, medication assisted therapy, and residential services (treatment and detoxification). The implementation of this benefit was a multi-step process: phase 1 began on 9/1/10, and phase 2 began on 1/1/11. 

Additional Background Information

The Legislature directed HHSC to analyze and provide data to the Legislative Budget Board (LBB) about the provision of substance use disorder treatment services before the 2013 legislative session. It is assumed that the comprehensive Medicaid substance use disorder benefit will result in Medicaid savings that will offset the cost of the benefits. The legislation states that HHSC may not continue to provide treatment services if the LBB determines that the services resulted in an increase in overall Medicaid spending.  More information on substance abuse benefits can be found in the LBB report “Texas State Government Effectiveness and Efficiency.”


HHSC is hosting a series of region-based trainings for Substance Use Disorder treatment providers on health plan-specific billing and prior authorization requirements related to Medicaid managed care health plans (STAR and STAR+PLUS).   Trainings are follow-up to a comprehensive SUD treatment training webinar conducted by HHSC on June 17, 2011.

The first training takes place Monday, August 8, 2011 in San Antonio. For more information and a complete training schedule, please see the document below:

To register, click here.


Last updated August 3, 2011