If you or a loved one is struggling with a substance use disorder and covered under a Fidelis
Care Medicaid plan, the cost of treatment may not be the barrier it seems. At Hoboken Counseling Center, we work directly with Fidelis Care to help members verify their benefits, understand
their coverage, and begin treatment with as little friction as possible. Our admissions team
is dedicated to ensuring that financial uncertainty never prevents someone from accessing the
life-changing care they need and deserve.
What Is Fidelis Care?
Fidelis Care is a New York-based health insurance company and a subsidiary of Centene
Corporation that has been serving New York State residents for more than 25 years. Fidelis
Care offers a range of health insurance plans including Medicaid Managed Care, Medicare
Advantage in partnership with Wellcare, Qualified Health Plans through the state
marketplace in partnership with Ambetter, and Child Health Plus. With 20 community
offices located throughout New York State — including regional offices in New York City,
Buffalo, Albany, Syracuse, and Rochester — Fidelis Care maintains a strong, accessible
presence across the state and is committed to providing affordable, quality healthcare to its
members.
For members enrolled in a Fidelis Care Medicaid Managed Care plan, behavioral health
services — including substance use disorder treatment and mental health care — are a covered
benefit. Federal and New York State parity laws require that these services be covered at a
level comparable to physical health benefits, meaning addiction treatment is not treated as a
lesser need.
Does Fidelis Care Medicaid Cover Addiction Treatment?
Yes. Under the Affordable Care Act (ACA), substance use disorder treatment is classified
as an essential health benefit, which means all qualifying health insurance plans — including
Medicaid — are required to provide coverage for medically necessary addiction treatment
services. Fidelis Care Medicaid plans cover a broad continuum of care for substance use
disorders, from medically supervised detoxification and residential inpatient treatment to
structured outpatient programming including Partial Hospitalization Programs (PHP) and
Intensive Outpatient Programs (IOP).
The specific benefits available to you will depend on your individual plan and clinical
necessity determinations. That is why our insurance specialists work directly with Fidelis
Care on your behalf to confirm coverage, identify any applicable out-of-pocket costs, and
clarify any preauthorization requirements before treatment begins. We offer a free,
confidential benefits check so you have a clear, complete picture of your coverage before
you take the next step.
Have Insurance Coverage with
Fidelis ?
coverage and take the first step toward recovery.
Addiction Treatment Programs Covered by Fidelis Care Medicaid
Fidelis Care Medicaid coverage is built to support members at every stage of the recovery
process. Our clinical team works in coordination with your plan to help you access and
maximize benefits across all applicable levels of care.
Medical Detoxification
Medical detox is the clinically supervised first phase of addiction treatment, providing
a safe and structured environment for the body to clear itself of harmful substances under
continuous professional oversight. Our medical detox program follows three core phases:
comprehensive clinical evaluation, medical stabilization, and coordinated
transition into the next appropriate level of care. Clients receive around-the-clock
monitoring, evidence-based withdrawal management, and medication-assisted treatment (MAT)
as clinically indicated. Medical detoxification is generally covered by Fidelis Care Medicaid
plans when deemed medically necessary, and program lengths typically span approximately seven
days depending on individual clinical need.
Residential Inpatient Treatment
For individuals who require an immersive, live-in treatment environment with full-time
clinical support, residential inpatient treatment removes clients from the triggers and
instability of their day-to-day environment and places them within a structured, therapeutic
setting focused entirely on recovery. Programming typically ranges from 30 to 90 days and
incorporates individual therapy, group counseling, psychiatric services, medication
management, and holistic wellness activities into a comprehensive daily schedule. Fidelis Care
Medicaid coverage often extends to residential inpatient treatment when clinically indicated,
and our team can verify your specific plan parameters and coordinate any required
authorizations on your behalf.
Partial Hospitalization Program (PHP)
PHP provides high-intensity, structured therapeutic programming during standard daytime
hours, allowing individuals to return home or to a sober living environment each evening.
These programs bring together individual counseling, group therapy, psychiatric consultation,
and medical monitoring within a coordinated, multidisciplinary care framework. PHP serves as
an effective bridge between inpatient and outpatient levels of care and is commonly covered
by Fidelis Care Medicaid when clinical criteria support this level of treatment. Our
admissions team handles all necessary verification and authorization procedures on your
behalf.
Intensive Outpatient Program (IOP)
IOP provides consistent, meaningful clinical support for individuals who are stable
enough to manage daily responsibilities — such as work, school, or family commitments —
while continuing to engage in structured treatment. Sessions typically convene multiple times
per week over extended treatment blocks and focus on relapse prevention, coping skill
development, peer accountability, and therapeutic reinforcement. IOP programs generally last
between six weeks and three months. Fidelis Care Medicaid coverage frequently includes IOP
as part of a comprehensive continuum of addiction care.
Medication-Assisted Treatment (MAT)
Medication-Assisted Treatment combines FDA-approved medications with counseling and
behavioral therapies to address the full scope of addiction — managing withdrawal symptoms,
reducing cravings, and lowering the risk of relapse. MAT is particularly effective in
treating opioid use disorder and alcohol use disorder. Medications that may be
covered under Fidelis Care Medicaid include:
- Buprenorphine / Suboxone / Sublocade — monthly injections or sublingual formulations
used to treat opioid use disorder - Methadone — a long-acting opioid agonist used for opioid dependence management
- Naltrexone / Vivitrol — monthly injections used to reduce cravings and support
recovery from both opioid and alcohol use disorders
Fidelis Care Medicaid plans typically cover MAT services, including both the medications
themselves and the clinical support services that accompany ongoing treatment.
Virtual Addiction Treatment
For members who face geographic, logistical, or personal barriers to in-person care,
virtual addiction treatment provides a clinically effective and flexible alternative.
Through secure telehealth platforms, clients can access individual therapy, group counseling,
and medication management consultations from the privacy and comfort of their own home.
Fidelis Care Medicaid may extend coverage to virtual treatment services, allowing members to
engage in evidence-based programming while maintaining the demands of everyday life. Please
note that Medicaid coverage is generally limited to services delivered within New York State.
Coverage Options Made Simple
Mental Health and Co-Occurring Disorder Coverage
Substance use disorders and mental health conditions frequently occur together. Many
individuals seeking addiction treatment are simultaneously managing underlying conditions
such as depression, anxiety, PTSD, bipolar disorder, personality disorders, or trauma-related
presentations — a clinical reality known as a co-occurring disorder or dual diagnosis.
New York State and federal behavioral health parity laws require Medicaid Managed Care plans
like Fidelis Care to provide comprehensive coverage for both substance use disorder and mental
health treatment, ensuring members have access to integrated, whole-person care.
Our clinical team specializes in dual diagnosis treatment, addressing substance use and
co-occurring mental health conditions simultaneously through personalized, coordinated care
planning. Services commonly covered by Fidelis Care Medicaid include psychiatric
evaluations, medication management, individual therapy, group counseling,
crisis support, and specialized behavioral health programming tailored to each member’s
specific clinical needs.
Psychiatric Services
Access to licensed psychiatrists and psychiatric nurse practitioners is a foundational
component of effective addiction and mental health treatment. Fidelis Care Medicaid plans
typically cover psychiatric evaluation and ongoing medication management, ensuring members
receive the level of specialized mental health care their diagnosis requires throughout every
stage of the recovery process.
Therapy and Counseling
Therapeutic services are at the heart of building the insight, skills, and behavioral
patterns that support lasting recovery. Whether working one-on-one with a licensed therapist
or engaging in structured group counseling, our qualified clinical staff deliver targeted,
evidence-based care within the scope of your Fidelis Care Medicaid benefits. Treatment
modalities available through our program include Cognitive Behavioral Therapy (CBT),
Dialectical Behavior Therapy (DBT), trauma-informed care, motivational interviewing,
family therapy, and relapse prevention programming.
Crisis Support Services
Fidelis Care Medicaid plans include coverage for behavioral health crisis support,
providing members with access to immediate clinical intervention during a mental health or
substance use emergency. If you or a loved one is experiencing a crisis, support is available
24 hours a day, 7 days a week. Members are encouraged to contact Fidelis Care’s crisis line
or seek emergency care at the nearest facility — your coverage extends to emergency behavioral
health services regardless of network status.
Clinical Assessments and Diagnostic Services
Individualized, effective treatment planning begins with a thorough clinical and medical
evaluation. Upon entering our program, every client undergoes a comprehensive intake
assessment that examines physical health status, substance use history, mental health
presentation, co-occurring conditions, and relevant psychosocial factors. Our team uses
standardized psychological screening tools, comprehensive psychiatric examinations, substance
use screening protocols, and integrated mental health appraisals to develop a complete
clinical profile that directly informs each client’s personalized treatment plan.
Clinical assessment and diagnostic services are typically covered by Fidelis Care Medicaid
plans.
Aftercare and Continuing Support
Long-term sobriety depends as much on what happens after primary treatment ends as on the
treatment itself. Fidelis Care Medicaid coverage may extend to aftercare and continuing
care services designed to reinforce the progress made during treatment and provide the
ongoing accountability and support needed to sustain recovery. Our aftercare planning team
collaborates with each client to connect them with the resources best suited to their
individual needs. These may include continued outpatient therapy, alumni programming,
community peer support groups, relapse prevention check-ins, and connections to local
recovery community organizations — all designed to serve as a reliable bridge between
intensive treatment and independent life in recovery.
Questions About Insurance?
Find out exactly what your plan covers. We make insurance verification fast, easy, and private.
How to Use Your Fidelis Care Medicaid Benefits at Guardian Recovery
Starting treatment with your Fidelis Care Medicaid plan is a straightforward process, and
our admissions team is ready to guide you through every step with clarity and compassion.
Here is what to expect when you reach out:
Our dedicated admissions coordinators will collect your Fidelis Care insurance information,
thoroughly review your specific plan details, and clearly explain which services are covered
— including any applicable copays, deductibles, and prior authorization
requirements. From there, we will schedule your initial clinical assessment and ensure you
feel fully informed and supported as you move forward with your treatment decisions. We manage
the insurance coordination so you can focus entirely on your recovery.
Whether you are reaching out for yourself or on behalf of a loved one, our team is available
24 hours a day, 7 days a week to answer questions, address concerns, and provide the
knowledgeable, compassionate guidance that makes the first step feel a little less
overwhelming.
Do not let uncertainty about your Fidelis Care coverage delay your path to healing.
Contact us today for your free, no-obligation benefits verification and take the first step
toward lasting recovery.
