Life is full of challenges and possibilities. However, being involved in the depths of substance use disorder can make life more complicated and unpleasant. You can become irritable, lose income, or lose family and friends as you combat mental health challenges.
You are not alone in this fight for survival. Alcohol and drugs may have offered an escape from reality, but now you or your loved one’s life has been turned upside down. You can find real freedom from substance use disorder with the choice of sobriety. NH Healthy Families provides coverage for rehab treatment and other services to treat addiction to alcohol and drugs along with any accompanying mental health issues.
NH Healthy Families
NH Healthy Families provides New Hampshire residents standard care that comes with the nationwide Medicaid plan plus so much more. The insurer offers the following benefits:
• Doctor choice
• Behavioral health coverage
• Private nurse advice line
• Cellphone allowance
• Rewards program
• Vision services
• Coordinated care
• Disease management
• Physician visits
• Health care screenings
• Language translation
• Pregnancy services
• Family planning
• Support services
Typical annual enrollment begins in late October to early December. You can also enroll in health care plans during a qualifying event, such as:
• Loss of employment
• Birth of a child
• Moving event
NH Healthy Families has several health care plans. All plans follow the guidelines as recommended by the Department of Health and Human Services.
Some plans offer patients behavioral health services. A person seeking addiction treatment would contact their primary care physician to coordinate care and obtain benefits.
Covered services may have coverage limitations, so you may need a doctor’s order with prior authorization for approval.
When you need a behavioral health care professional, simply contact an in-network provider. You do not need a referral from your primary care provider for care. However, if you desire to visit an out-of-network provider, you will need prior authorization.
Behavioral health services will require prior authorization, especially for the NH Healthcare Protection Program. These include substance use disorder services, pain management, and outpatient therapy services. All covered services must be medically necessary to be covered.
NH Healthy Families Ambetter
NH Healthy Families offers plans from Ambetter. You can choose from three distinct plans from the Ambetter family. Which different level of care you choose will depend upon your family income and your desired deductible and out-of-pocket expenses.
• Bronze Level Services: Ambetter Essential Care
Essential care will cover your basic health care needs. You will have lower monthly premiums, but you may pay a higher out-of-pocket cost for any unexpected health care needs.
• Silver Level Services: Ambetter Balanced Care
With silver level services, you will get the most value for your health care dollars. As you may be eligible for financial assistance with this plan, there is a balance between your monthly premiums and out-of-pocket expenses.
• Gold Level Services: Ambetter Secure Care
Ambetter Secure Care will grant you great peace of mind with minimal out-of-pocket costs. However, you can expect to pay higher premiums.
All plans offer essential services at different price points. You will have access to the minimum health care services for your family, including these services:
• Mental health treatment
• Substance abuse treatment
• Pediatric care
• Maternity services
• Preventative care
• Laboratory testing
• Prescription drugs
• Outpatient services
• Ambulatory care
Main Ambetter Balanced Care Plans
Ambetter Balanced Care offers plans in three main categories for households that are within 300% of the poverty line. As standard, services are covered for behavioral health. The standard deductible is $3,350 for an individual and $6,750 for a family.
• Inpatient services: You only pay a $750 deductible for residential treatment. In some cases, you may need prior authorization. Out-of-network visits are not covered.
• Outpatient services: For each doctor visit, there is a $30 copay. The deductible does not apply. When you visit your PCP or primary practitioner, you will not need prior authorization, and out-of-network visits are not covered. You will have a 30% coinsurance for any additional outpatient services.
Ambetter Essential Care
These plans are for households that are within 100% to 300% of the national poverty line. The standard deductibles are higher. For example, the Ambetter Essential Care plan has a standard individual deductible of $8,150 for an individual and $16,300 for a family.
However, once you meet the deductible, you will not have to pay anything for behavioral health or substance abuse services. Out-of-network treatment is not covered. You can arrange appointments with your PCP without prior authorization. Other services, however, may require additional approval from the insurance carrier.
Ambetter Balanced Care-Cost Sharing
This plan does not have any deductibles. It is for households that are over 100% of the poverty line. The out-of-pocket maximum can range from $2,750 for individuals to over $5,400 for families.
• Inpatient services: For residential treatment, you will have a 40% coinsurance. Just like the other plans, out-of-network services are not available.
• Outpatient services: PCP visits are included with a $15 copay per office visit. Other outpatient services require coinsurance of 40%.
NH Healthy Families members have access to pharmaceutical services for drugs that are on the approved formulary. Both over-the-counter and prescribed drugs are available for use. Each tier will have its corresponding copayments.
Some drugs have quantity limitations or may require prior authorization. You can easily find a local pharmacy with the Find A Provider tool on the website. Walgreens is a significant participant in the pharmacy benefits. Below are a few common drugs found on the formulary list.
• Lithium carbonate
• Haldol Decanoate
Behavioral Health Treatment
Members of NH Healthy Families have access to preventative behavioral health care programs. For a comprehensive treatment, members will have access to the following services:
• Inpatient hospitalization services
• Outpatient hospitalization services
• Inpatient psychiatric care
• Mental health case management
• Behavioral health with child welfare
• Therapeutic foster care
• Behavioral health for substance use disorder
• Residential care
• Behavioral care mental health
• Psychological testing
• ABA services for people with autism
NH Healthy Families follows the guidelines as published by the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association. The evidence-based approach is observed for the treatment of substance use and abuse, post-traumatic stress disorder, schizophrenia, bipolar disorder, and depression.
Facilities in the NH Healthy Families network are certified, monitored, and regulated for quality of care. During and after treatment, patients will have access to case management services and continuity of care. All medical records are kept in confidentiality.
To verify your eligibility for NH Healthy Families, contact customer service at 1 (866) 769-3085. A customer service agent will verify your eligibility, describe your medical benefits, advise you on obtaining the proper authorizations, give referrals, and provide interpretation and translation services.
Recovery Rewards Program
The Ready for My Recovery rewards program wants to incentivize you to remain healthy while maintaining your sobriety from drugs or alcohol. The program is for individuals who are committed to entering a behavioral health program. You will have the opportunity to take advantage of the case management resources and rewards just by being a member of the NH Healthy Families program.
To participate in the Ready for My Recovery rewards program, the first task you will want to complete is filling out the Health Risk Assessment Screening form. The insurer’s website has downloadable forms and envelopes.
After you complete and submit the forms, a staff member will contact and advise you about the Ready for My Recovery assistance program. Member services will send you a welcome kit within two weeks of signing up for an offer. Your welcome kit will not only include a backpack, but you will also get a water bottle, a deluxe journal and pen, a self-care kit, and additional behavioral health resources.
As a member of the Ready for My Recovery program, you will have access to earn many rewards as you complete milestones on your path to recovery. Earn rewards for:
• 12-step program participation
• Physician treatment visits
• Peer support services
• Behavioral therapy for substance use disorder
• SMART Recovery participation
Once enrolled in the program, you will receive a My Health Pays Visa rewards card in the mail. Use the card to purchase everyday grocery items in stores like Walmart and Target. You can also pay your monthly household bills, which include rent and utilities, with the prepaid Visa card.
As a member, you can earn up to $250 per year. Rewards renew every benefit year on June 30. The average award ranges from $25 to $30 per incident. You can earn certain rewards with one month, six months, and one year of continuous service for billable hours.
When you complete your one year of service, you can continue to obtain rewards for any 12-step or SMART Recovery services for which you are enrolled on a six-month rolling basis. If you happen to leave the program, you remain eligible for care management assistance that will help you cope with alcohol and tobacco cessation.
Green Mountain Treatment Center
Green Mountain Treatment Center is situated in the lovely atmosphere of Effingham, NH. We provide superior recovery facilities for adult men and women who are over the age of 18. Come and recuperate at our secluded facility, which offers sweeping views of New Hampshire’s White Mountains and stunning lakes while you enjoy the apple orchards and fresh mountain air.
To completely understand the effects of addiction, a person must uncover the triggers that led to addiction. We seek to help you undergo inner healing so that you can enjoy prime physical health. We have licensed case managers, psychiatrists, and master’s-level clinicians who will help you do that deep introspective work to facilitate complete recovery.
Individualized Treatment Plans
We use evidenced-based therapies with the 12-step curriculum to promote health and healing. Every individual is different. Therefore, we tailor each treatment plan that corresponds to a person’s diagnosis. We practice holistic treatment as care for the entire person. At Green Mountain Treatment Center, you can experience true healing and recovery for the mind, body, and soul.
Clinical and Holistic Treatment
We desire that you be completely comfortable when you enroll in a program at Green Mountain Treatment Center. Upon entrance into our residential treatment program, you will be paired with a peer who has had similar experiences with substance use disorder and recovery. Your peer partner will help you assimilate into your new environment while acting as your mentor. Together, you will attend group meetings and counseling sessions.
Substance use disorder can be painful on the body. Therefore, we offer a world-class medical detoxification facility that is staffed 24/7 with compassionate health professionals. You’ll detox while our nursing staff monitors your recovery from medium to high withdrawal risk.
Holistic treatment motivates you to stay on the path of sobriety. To complete your stay, we offer a complete and comprehensive program in addition to evidence-based clinical treatment. Our facility offers:
• Gym facilities
• Education programs
• Nutritious meals
• Yoga and meditation
• Treatment for mental health disorders
• Relaxation activities
For assistance, contact our care center today. We are in-network with many major insurance carriers, so you can call to determine whether your treatment will be covered. We will happily answer any questions you may have.