Compare reported Medicare and Medicaid acceptance at substance use IOP and residential treatment facilities in SAMHSA’s 2024 public-use survey.
In SAMHSA’s 2024 survey, 3,037 of 6,921 included facility records offering substance use IOP (43.9%) and 808 of 3,490 offering non-hospital residential substance use treatment (23.2%) reported accepting both Medicare and Medicaid for substance use services.
These are facility-level responses in the 50 states and DC. The survey asks about accepted payments for the facility’s substance use services as a whole. Use the counts for planning and verify payment for a specific program or referral separately. Download the national and state counts (CSV).
How many substance use treatment sites report accepting Medicare and Medicaid?
The national counts below use only facility records with a yes or no answer to both payment items. The first two rows overlap. The third row shows that intersection. It includes 974 records that reported both types of treatment and had valid payment answers.
| Treatment offered | Valid payment answers | Both accepted | Medicaid only | Medicare only | Neither reported |
|---|---|---|---|---|---|
| Intensive outpatient | 6,921 | 3,037 (43.9%) | 2,302 | 126 | 1,456 |
| Non-hospital residential treatment | 3,490 | 808 (23.2%) | 1,409 | 59 | 1,214 |
| Both settings | 974 | 275 (28.2%) | 359 | 14 | 326 |
“Only” compares these two survey items. A facility could report other payment types. The gap between the two setting percentages describes the survey responses. It does not establish why a site accepts a payment type or which treatment a plan will pay for.
Compare the state counts and denominators
The numerator is the number reporting both types of payment. The denominator is the number with a yes or no answer to each payment item in that group. Use the counts with the percentages, especially where the denominator is small. The CSV also includes missing responses, the four payment combinations, and the overlapping group by state.
| Geography | IOP reporting both / valid | Residential reporting both / valid |
|---|---|---|
| US (50 states and DC) | 3,037 of 6,921 (43.9%) | 808 of 3,490 (23.2%) |
| AK | 22 of 42 (52.4%) | 9 of 20 (45.0%) |
| AL | 18 of 40 (45.0%) | 4 of 28 (14.3%) |
| AR | 25 of 51 (49.0%) | 10 of 30 (33.3%) |
| AZ | 120 of 231 (51.9%) | 30 of 122 (24.6%) |
| CA | 130 of 590 (22.0%) | 60 of 619 (9.7%) |
| CO | 62 of 157 (39.5%) | 5 of 46 (10.9%) |
| CT | 68 of 93 (73.1%) | 11 of 35 (31.4%) |
| DC | 7 of 14 (50.0%) | 0 of 5 (0.0%) |
| DE | 18 of 30 (60.0%) | 2 of 12 (16.7%) |
| FL | 43 of 249 (17.3%) | 24 of 176 (13.6%) |
| GA | 57 of 128 (44.5%) | 28 of 85 (32.9%) |
| HI | 15 of 70 (21.4%) | 1 of 15 (6.7%) |
| IA | 40 of 85 (47.1%) | 9 of 37 (24.3%) |
| ID | 31 of 79 (39.2%) | 3 of 12 (25.0%) |
| IL | 124 of 353 (35.1%) | 29 of 94 (30.9%) |
| IN | 107 of 172 (62.2%) | 39 of 85 (45.9%) |
| KS | 28 of 76 (36.8%) | 3 of 27 (11.1%) |
| KY | 180 of 272 (66.2%) | 47 of 128 (36.7%) |
| LA | 40 of 125 (32.0%) | 6 of 49 (12.2%) |
| MA | 57 of 95 (60.0%) | 57 of 116 (49.1%) |
| MD | 138 of 263 (52.5%) | 64 of 162 (39.5%) |
| ME | 20 of 30 (66.7%) | 6 of 16 (37.5%) |
| MI | 90 of 152 (59.2%) | 22 of 72 (30.6%) |
| MN | 84 of 250 (33.6%) | 17 of 101 (16.8%) |
| MO | 81 of 143 (56.6%) | 26 of 57 (45.6%) |
| MS | 25 of 44 (56.8%) | 6 of 28 (21.4%) |
| MT | 8 of 49 (16.3%) | 2 of 11 (18.2%) |
| NC | 117 of 205 (57.1%) | 11 of 70 (15.7%) |
| ND | 16 of 43 (37.2%) | 9 of 24 (37.5%) |
| NE | 24 of 37 (64.9%) | 11 of 38 (28.9%) |
| NH | 9 of 30 (30.0%) | 0 of 14 (0.0%) |
| NJ | 122 of 269 (45.4%) | 10 of 59 (16.9%) |
| NM | 20 of 41 (48.8%) | 3 of 21 (14.3%) |
| NV | 37 of 74 (50.0%) | 9 of 30 (30.0%) |
| NY | 110 of 189 (58.2%) | 56 of 187 (29.9%) |
| OH | 297 of 465 (63.9%) | 50 of 126 (39.7%) |
| OK | 41 of 64 (64.1%) | 3 of 28 (10.7%) |
| OR | 29 of 113 (25.7%) | 8 of 42 (19.0%) |
| PA | 76 of 268 (28.4%) | 20 of 146 (13.7%) |
| RI | 17 of 21 (81.0%) | 6 of 13 (46.2%) |
| SC | 7 of 40 (17.5%) | 2 of 16 (12.5%) |
| SD | 8 of 26 (30.8%) | 3 of 18 (16.7%) |
| TN | 61 of 181 (33.7%) | 13 of 67 (19.4%) |
| TX | 95 of 285 (33.3%) | 7 of 107 (6.5%) |
| UT | 58 of 158 (36.7%) | 21 of 93 (22.6%) |
| VA | 87 of 123 (70.7%) | 14 of 46 (30.4%) |
| VT | 6 of 6 (100.0%) | 1 of 4 (25.0%) |
| WA | 73 of 258 (28.3%) | 9 of 53 (17.0%) |
| WI | 37 of 76 (48.7%) | 6 of 44 (13.6%) |
| WV | 23 of 30 (76.7%) | 7 of 40 (17.5%) |
| WY | 29 of 36 (80.6%) | 9 of 16 (56.3%) |
How overlapping treatment settings affect the comparison
Of the 6,921 IOP records with valid payment answers, 974 also reported residential treatment. Those same 974 records are also included among the 3,490 residential records with valid payment answers. For a question specifically about facilities that offer both settings, use the separate intersection row. Its 275 records reporting both payment types should not be added to either setting’s count.
How we counted the survey responses
We used SAMHSA’s 2024 National Substance Use and Mental Health Services Survey public-use release and selected records for the 50 states and DC using LOCATIONSTATE.
- IOP. We included records with
CTYPE2 = 1, indicating substance use intensive outpatient treatment. - Non-hospital residential treatment. We included records with
CTYPE7 = 1and at least one ofCTYPERC3 = 1orCTYPERC4 = 1. Those flags indicate short-term and long-term residential substance use treatment. Residential detox alone does not meet this filter. - Both settings. We applied both filters to the same record.
- Payment answers. We counted
REVCHK5_SUfor Medicaid andREVCHK8_SUfor Medicare. Both must be0or1. We report the missing or skipped payment records separately in the CSV. - Aggregation. We counted unweighted facility records and rounded percentages to one decimal. A facility that reported both services appears in both setting groups. We compared an independent SQL tabulation against every row in the file.
See questionnaire A17 for the payment question and the codebook for field definitions. The survey covers reported services and accepted payment types in 2024. It does not track available slots, patient eligibility, or what happened to individual claims.
Use the findings for admissions planning
Use the state counts to frame questions about the locations and services in a referral network. Verify current plan participation, the proposed service and date, and any applicable authorization requirement separately. The treatment center verification of benefits guide explains what to record at each step.
For a related comparison, see Medicaid and private insurance at substance use IOP facilities. Browse the behavioral health research catalog for the other survey analyses and data downloads.
Frequently Asked Questions
How many substance use IOP facilities reported accepting both Medicare and Medicaid?
In the 2024 SAMHSA public-use file, 3,037 of 6,921 IOP facility records (43.9%) with yes or no answers to both payment items reported accepting both. The analysis covers the 50 states and DC.
How many residential substance use facilities reported accepting both?
Of 3,490 facility records offering short-term or long-term non-hospital residential substance use treatment with two valid answers, 808 (23.2%) reported accepting both.
Can the same facility appear in both settings?
Yes. The analysis counted 974 records reporting both settings with valid answers to the two payment questions. Of those, 275 (28.2%) reported accepting both Medicare and Medicaid.
What does the payment answer mean for an individual referral?
The survey asks about acceptance for substance use services at the facility. Confirm the specific plan, service, location, and any authorization requirements for the referral with the facility and the plan.
