11,500+ verified treatment programs · Real Options, Real Recovery
Original research
A 2024 facility-level analysis of how U.S. substance use treatment facilities report participating with private insurance, Medicaid, and Medicare — and how participation differs by service type and state.
Research & analysis by Treatment Locators · Published September 10, 2026 · Source: SAMHSA 2024 N-SUMHSS facility-level public-use file · Methodology & sources
78.3%
Report participating with private insurance
12,494 of 15,953 facilities
77.8%
Report participating with Medicaid
12,418 of 15,953 facilities
52.6%
Report participating with Medicare
8,397 of 15,953 facilities
Payer participation reflects what facilities reported to SAMHSA. It does not guarantee coverage for a specific plan, network status, authorization, admission, or treatment availability.
Section 1 · National overview
Across 15,953 substance use treatment facilities in SAMHSA's 2024 analytic universe, 78.3% reported participating with private insurance, 77.8% with Medicaid, and 52.6% with Medicare. Those national figures change substantially when the data are broken out by treatment service.
SAMHSA 2024 N-SUMHSS public-use file, substance use analytic universe (TSU_SU = 1).
Of 15,953 substance use treatment facilities, 12,494 (78.3%) reported participating with private insurance, 12,418 (77.8%) with Medicaid, and 8,397 (52.6%) with Medicare.
Facilities (N) = 15,953
Reading this chart
At the national level, reported private-insurance and Medicaid participation look broadly similar. Medicare stands out immediately: just over half of facilities reported participating with it, roughly 25 percentage points below the other two categories.
What it means
Even that national difference understates how wide the Medicare gap becomes in particular treatment settings.
When facilities are separated by the services they actually provide, the payer picture changes substantially — which is why the sections below are reported service by service rather than as a single nationwide statistic.
Section 2 · Residential treatment
Only 21% of residential withdrawal-management facilities, 23.9% of short-term residential facilities, and 23.5% of long-term residential facilities reported participating with Medicare. Private-insurance participation was substantially higher in each of the three validated residential service categories.
Each bar uses its own denominator. Broad “any residential” rates are not shown — see methodology.
Across the three validated residential service components, reported Medicare participation remains near one-quarter or lower, while reported private-insurance participation ranges from about 64 to 87 percent.
Facilities (N) = 1,317
Facilities (N) = 2,460
Facilities (N) = 2,732
Reading this chart
Across all three validated residential service categories, fewer than one in four facilities reported Medicare participation. That consistency is notable: the pattern is not confined to a single residential service, but holds across withdrawal management, short-term residential treatment, and long-term residential treatment.
What it means
This does not mean Medicare beneficiaries cannot obtain residential addiction treatment.
It does mean the pool of facilities reporting Medicare participation is substantially smaller than the pool reporting private-insurance participation in these categories.
Section 3 · Withdrawal management by setting
Among facilities providing withdrawal management, reported Medicare participation ranged from 70.6% in outpatient settings to 55.4% in hospital inpatient settings and 21% in residential settings. Medicaid participation showed a similar, though less dramatic, decline across those settings.
These three settings are reported separately and are not averaged together.
Reported payer participation among withdrawal-management facilities differs sharply by setting: outpatient, residential, and hospital inpatient settings each carry their own denominator and their own participation pattern.
Facilities (N) = 1,579
Facilities (N) = 1,317
Facilities (N) = 784
Reading this chart
The same broad treatment need produces very different payer-participation patterns depending on where the care is delivered. For Medicare, reported participation falls from 70.6% in outpatient withdrawal management to 55.4% in hospital inpatient settings and 21% in residential settings — a difference of 49.6 percentage points between the outpatient and residential categories.
What it means
Treatment Locators also examined facilities reporting at least one of those three validated settings.
After removing facilities appearing in more than one category, the analysis identified 3,086 unique facilities, of which 87.9% reported participating with private insurance, 69.5% with Medicaid, and 52.6% with Medicare. That deduplicated view still shows a substantial private-versus-Medicare difference, but the setting-level figures remain the more informative comparison.
Section 4 · Opioid treatment programs
Among 2,224 SAMHSA-certified opioid treatment programs, 81.5% reported participating with private insurance, 87.1% with Medicaid, and 80.1% with Medicare. That comparatively balanced payer pattern is a reminder that insurance participation cannot be generalized across treatment modalities.
Certified OTPs only (OTXFEDOTP = 1).
Among 2,224 certified opioid treatment programs, reported participation was 81.5% private insurance, 87.1% Medicaid, and 80.1% Medicare.
Facilities (N) = 2,224
Reading this chart
Medicaid participation was actually the highest of the three payer categories here, and reported Medicare participation among OTPs was nearly four times the rate observed among residential withdrawal-management facilities.
OTP certification and reported payer participation do not guarantee coverage for a specific medication, admission, or network status with any particular plan.
What it means
That contrast matters. It suggests payer participation is not simply a function of whether treatment addresses substance use — it is strongly associated with the type of treatment service being delivered.
Section 5 · Two national spotlights
Day treatment and partial hospitalization show one of the widest private-versus-Medicare differences in the file. Regular outpatient treatment shows private and Medicaid participation running nearly level.
Difference between reported private-insurance and Medicare participation: 53.9 percentage points.
Among 2,389 day treatment or partial hospitalization facilities, reported participation was 90.7% private insurance, 65% Medicaid, and 36.8% Medicare.
Facilities (N) = 2,389
The largest service category in the file, and the most evenly balanced between private insurance and Medicaid.
Among 12,307 regular outpatient facilities, reported participation was 80.1% private insurance, 81% Medicaid, and 57% Medicare.
Facilities (N) = 12,307
90.2 pts
One of the widest headline-eligible state/service splits in the analysis: 97.8% of Florida’s 92 residential withdrawal-management facilities reported participating with private insurance, against 7.6% reporting Medicare. Reported participation is not coverage, network status, or admission.
Section 6 · Interactive state explorer
Use the map and table to compare facility-reported payer participation by state and treatment service. State percentages should always be read alongside the number of facilities in the selected service category.
| Payer N | Publication tier | |||
|---|---|---|---|---|
| Florida | 97.8% | 90 | 92 | Headline eligible |
| Texas | 93.3% | 56 | 60 | Headline eligible |
| New York | 90.0% | 45 | 50 | Headline eligible |
| Pennsylvania | 88.1% | 52 | 59 | Headline eligible |
| California | 87.6% | 298 | 340 | Headline eligible |
| Illinois | 96.7% | 29 | 30 | Usable with N shown |
| Indiana | 91.4% | 32 | 35 | Usable with N shown |
| Ohio | 89.4% | 42 | 47 | Usable with N shown |
| Kentucky | 87.5% | 28 | 32 | Usable with N shown |
| Maryland | 83.7% | 36 | 43 | Usable with N shown |
| Michigan | 73.3% | 22 | 30 | Usable with N shown |
| Georgia | 71.9% | 23 | 32 | Usable with N shown |
| Tennessee | 67.7% | 21 | 31 | Usable with N shown |
| Nevada | 100.0% | 10 | 10 | Directional only |
| Wisconsin | 100.0% | 10 | 10 | Directional only |
| Utah | 96.6% | 28 | 29 | Directional only |
| Massachusetts | 95.0% | 19 | 20 | Directional only |
| Virginia | 94.1% | 16 | 17 | Directional only |
| Oregon | 93.8% | 15 | 16 | Directional only |
| Missouri | 93.3% | 14 | 15 | Directional only |
| Minnesota | 92.9% | 13 | 14 | Directional only |
| New Jersey | 92.9% | 26 | 28 | Directional only |
| Wyoming | 91.7% | 11 | 12 | Directional only |
| Washington | 91.3% | 21 | 23 | Directional only |
| West Virginia | 90.9% | 10 | 11 | Directional only |
| Kansas | 88.2% | 15 | 17 | Directional only |
| Arizona | 83.3% | 15 | 18 | Directional only |
| Louisiana | 81.8% | 18 | 22 | Directional only |
| North Dakota | 81.8% | 9 | 11 | Directional only |
| Colorado | 73.1% | 19 | 26 | Directional only |
| North Carolina | 66.7% | 16 | 24 | Directional only |
| Mississippi | 53.8% | 7 | 13 | Directional only |
| Alabama | 100.0% | 2 | 2 | Small N — not ranked |
| Alaska | 100.0% | 1 | 1 | Small N — not ranked |
| Arkansas | 100.0% | 9 | 9 | Small N — not ranked |
| Connecticut | 100.0% | 6 | 6 | Small N — not ranked |
| Delaware | 100.0% | 1 | 1 | Small N — not ranked |
| Iowa | 100.0% | 9 | 9 | Small N — not ranked |
| Maine | 100.0% | 4 | 4 | Small N — not ranked |
| Montana | 100.0% | 5 | 5 | Small N — not ranked |
| Nebraska | 100.0% | 8 | 8 | Small N — not ranked |
| New Hampshire | 100.0% | 6 | 6 | Small N — not ranked |
| Rhode Island | 100.0% | 2 | 2 | Small N — not ranked |
| South Carolina | 100.0% | 5 | 5 | Small N — not ranked |
| Idaho | 87.5% | 7 | 8 | Small N — not ranked |
| Hawaii | 83.3% | 5 | 6 | Small N — not ranked |
| New Mexico | 66.7% | 6 | 9 | Small N — not ranked |
| South Dakota | 60.0% | 3 | 5 | Small N — not ranked |
| Oklahoma | 40.0% | 2 | 5 | Small N — not ranked |
State results include facility counts. Smaller groups should be interpreted cautiously, and groups with fewer than 10 facilities are excluded from comparative rankings. The full tier thresholds are described in the methodology below.
Section 7 · State case studies
Every figure below applies only to the named service category in that state — not to all treatment facilities there.
Florida
Facilities (N) = 92 in this service category
In Florida, 97.8% of 92 residential withdrawal-management facilities reported participating with private insurance, compared with 28.3% for Medicaid and 7.6% for Medicare — a private-to-Medicare difference of 90.2 percentage points within this service category.
California
Facilities (N) = 292 in this service category
California shows a repeated service-specific pattern. Among day treatment and partial hospitalization facilities, 96.6% reported private-insurance participation versus 21.2% Medicaid and 18.2% Medicare. Among 537 short-term residential facilities, the figures were 76.4%, 27.9%, and 11.5%, respectively.
Texas
Facilities (N) = 60 in this service category
In Texas, reported Medicare participation was 11.7% among 60 residential withdrawal-management facilities and 5.3% among 76 long-term residential facilities. Each figure describes only that service category.
Ohio
Facilities (N) = 131 in this service category
Ohio’s OTPs offer a counterexample: among 131 certified programs, 93.9% reported private-insurance participation, 98.5% Medicaid participation, and 93.9% Medicare participation.
Section 8 · Patient-side context
Among the specific 2024 NSDUH adult population with an unmet perceived need for substance use treatment, cost and coverage were commonly reported reasons for not receiving it. These figures describe that population only — not all U.S. adults, and not the facilities analyzed above.
Source: SAMHSA 2024 National Survey on Drug Use and Health detailed tables. Used here as patient-reported context only; it is a separate survey from the facility file and the two cannot be combined.
Findings
The clearest conclusion from the 2024 data is not that one payer universally provides better or worse addiction-treatment access — it is that payer participation varies dramatically across treatment services and locations.
Benefits and coverage should be verified directly with the insurer and the treatment provider.
Methodology
Every facility-level finding on this page is reproducible from SAMHSA's 2024 public-use data and published tables.
Charts, figures, and datasets on this page are published under a Creative Commons Attribution 4.0 licence. Attribute Treatment Locators and link to this page.
Treatment Locators. “Addiction Treatment & Insurance Access in America: A State-by-State Analysis.” Analysis of SAMHSA 2024 N-SUMHSS public-use data. https://treatmentlocators.com/research/insurance-access
Other Treatment Locators analyses built from federal treatment-facility data.
Report
The Detox Access Gap
How far communities are from a facility that reports detoxification services.
Guide
Levels of care explained
What each treatment setting in this analysis actually involves.
Guides
Insurance coverage by carrier
How major insurers handle detox, residential and outpatient treatment, and how to verify a program takes your plan.
Medically reviewed by Cole Timonere, PhD, JD, LMHC, LPCC
Licensed mental health and clinical counselor with doctoral and legal training, specializing in substance use disorders, withdrawal management, and behavioral health care. Reviews the clinical accuracy of the treatment guides on this site.
Editorial content — always confirm clinical details with a licensed provider.
Questions
Treatment Locators publishes SAMHSA-listed facilities by state and city, alongside plain guides to levels of care and how treatment is paid for. Listings reflect what facilities report to SAMHSA and do not confirm coverage, network status, or availability.
