Will Medicaid Cover Medical Marijuana?

If medical cannabis is legalized by almost every state in America, does the federal government have an obligation to allow cannabis healthcare appointments to be covered by medicare advantage plans or standard Medicaid and Medicare? Or cover medical cannabis supplies and the cost of products?

It is a question that many patients ask. Often, medical cannabis helps reduce the severity of symptoms, according to patient feedback. If that is the case, shouldn’t health insurers, including Medicare, cover medical marijuana?

We share the accepted medical experiences of patients and whether insurance or other programs can help alleviate the medical marijuana cost for Americans.

Why Doesn’t Medicare or Medicaid Cover Medical Marijuana?

Health insurers in the US will not cover costs for anything that is labeled as illegal. Most insurance policies include an “illegal acts” exclusion stating any health issues occurring due to or related to voluntary involvement in an illegal act are not covered.

Even though medical marijuana has been legalized in most states throughout the country, it is still classified by the federal government as a Schedule 1 controlled substance. This was defined in 1970 with the passing of the Controlled Substance Act. This legislation is still in effect today, meaning that technically medical marijuana cannot be covered by insurance companies, including Medicare.  

The Food and Drug Administration (FDA) poses another barrier to insurance coverage. Generally, insurance companies do not cover any drug that has not received FDA approval. As of now, the FDA has not legally approved medical marijuana for any indication.

While the FDA has yet to take any real steps toward approval, it does work alongside the Drug Enforcement Administration (DEA) and National Institute on Drug Abuse (NIDA) to support clinical research on medical marijuana. The FDA will want clinical studies to provide long-term data on the safety and effectiveness of marijuana as a medical treatment before it approves it as a medicine, so these studies will hopefully support that development.

What is Medicaid and Medicare?

Unfortunately, both Medicaid and Medicare will not cover medical cannabis costs for registered medical marijuana patients. But the programs are available to assist both seniors over the age of 65 or older or individuals who are physically disabled.

Adults who are low or very low income may qualify for Medicaid. Adolescents aged 18 or older may qualify for Medicaid if they meet the low-income requirements and need assistance.

Understanding Medicare Coverage

Medicare is the federal health insurance program for:

• People who are 65 or older

• Certain younger people with disabilities

• People with End-Stage Renal Disease

Medicare is divided into four parts. The different parts of Medicare help cover specific services:

• Medicare Part A (Hospital Insurance): Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

• Medicare Part B (Medical Insurance): Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services.

• Medicare Part C (MA Plans): Part C, also known as Medicare Advantage Plans (MA Plans), is an “all in one” alternative to Original Medicare. Private companies approved by Medicare offer them.

• Medicare Part D (prescription drug coverage). Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Understanding Medicaid Coverage

Eligibility for Medicaid coverage is dependent on income levels and assets. Only individuals who qualify as low or very low income may be approved.

Medicaid has the same basic qualifications in every state. And there are four programs of Medicaid that patients can apply for.

• Medicaid Buy-In for Adults.

• Medicaid Buy-In for Children.

• Medicaid for Children & Adults with Disabilities.

• Medicaid for the Elderly & People with Disabilities.

In 2023, the income requirement for a single adult person is $14,580, and $30,000 for a family of four. A family of eight people with a maximum income of $50,560 may also qualify for Medicaid.

Can Veterans Lose VA Benefits for Having a Medical Marijuana Card?

Additionally, if you have health coverage through the Veterans Administration (VA), you may use medical marijuana without fear of losing your benefits. If you currently use marijuana, tell your VA physician so he or she has the best picture of your overall health. 

However, If you need a marijuana recommendation, note that VA physicians cannot provide it. You also cannot ask a VA doctor to recommend you for a marijuana study. And if you do use medical marijuana, you cannot bring it onto VA property per federal laws, which overrule any state statutes.

Currently, none of the above cover the cost of medical marijuana in any state. Parts C and D could cover the cost of cannabinoid medications that have been approved by the FDA and are available without restriction. Cannabinoid medications, like dronabinol (Marinol, Syndros) and Epidiolex, could be covered by Medicare drug plans.

Medicaid and Medicare Prescription Cannabinoid Drug Plans

An FDA advisory panel has recommended the approval of an epilepsy drug, Epidiolex, that contains CBD. If it gets approved, it will become the first cannabis-derived prescription medication in the United States.

As for synthetic cannabis, the FDA approved three prescription drugs that contain synthetic forms of marijuana compounds or chemicals. Cesamet is one medication with the active ingredient nabilone. According to the FDA, nabilone “has a chemical structure similar to THC.” Doctors will prescribe this synthetic cannabinoid medicine to cancer patients struggling with nausea and vomiting after chemotherapy treatments.

The other two FDA-approved synthetic forms of marijuana on the market are Marinol and Syndros. They are used to treat nausea and vomiting, as well, but can also improve the appetite of people who are suffering from AIDS.

While those synthetic medications can be helpful in most cases, they do not offer the full potential benefits of whole-plant medical marijuana products. The cannabis plant consists of hundreds of chemicals that work together to produce the maximum benefits possible.

These synthetic alternatives do not include the full plant profile, can take longer for the effects to kick in, and can increase a person’s depression and anxiety. 

Will Legalizing MMJ Benefit the Insurance Companies?

In 2017, Health Affairs published a study finding that Medicare could have saved $1.01 billion if medical marijuana had been legalized on a national scale and covered by government insurance programs. The potential savings would have resulted from medical marijuana replacing more costly prescription medications.

In the states that have at least legalized marijuana for medical use, there has been a significant decrease in Medicare-issued opioid prescriptions. For example, prescriptions for morphine dropped by 20.7%, and hydrocodone prescriptions fell by 17.4 percent in those states with legal medicinal marijuana programs.

Qualifying for a Florida Medical Marijuana Card

When Medical Marijuana was passed in Florida, the state published a list of qualifications that must be met in order to qualify for a physician’s recommendation. [c]

A Qualified Patient Must:

• Be a permanent or seasonal Florida resident

• Be diagnosed with a qualifying medical condition by a qualified physician

• Be entered into the Medical Marijuana Use Registry

• Obtain a Medical Marijuana Use Registry Identification Card

Patients must first be diagnosed with a qualifying medical condition. Below are the state-approved conditions that allow one to qualify for their recommendation.

Qualifying Medical Conditions:

• Cancer

• Epilepsy

• Glaucoma

• HIV/AIDS

• Post-traumatic stress disorder (PTSD)

• Amyotrophic lateral sclerosis (ALS)

• Crohn’s disease

• Parkinson’s disease

• Multiple sclerosis (MS)

• Medical conditions of the same kind or class as or comparable to the others listed.

• A terminal condition is diagnosed by a physician other than the qualified physician issuing the physician certification.

• Chronic nonmalignant pain caused by a qualifying medical condition or that originates from a qualifying medical condition and persists beyond the usual course of that qualifying medical condition.

Medical marijuana and Medicaid or Medicare options to provide coverage may not exist right now. But as more evidence-based research emerges, and the possibility of federal legalization or rescheduling of cannabis on the controlled substances act (CSA), there may be a time when insurance coverage becomes available, which will be to the benefit of patients that rely on medical marijuana as part of their personal treatment plan.

How Do I Get My Medical Cannabis Card?

Once approved by a medical cannabis physician, the patient will receive a certification letter from the doctor. That letter is required to apply for a medical card, and it means that a physician has discussed and reviewed your diagnosis and symptoms. And that those conditions allow you to be qualified to apply for a medical marijuana card.

DocMJ has been assisting patients with cannabis healthcare appointments since 2016. We provide support and education to help you on your wellness journey and assist every step of the way in making applying for a medical marijuana card easier for patients.