TRUSTED CONTENTOur analysis of SAMHSA’s 2025 National Directory of Drug and Alcohol Use Treatment Facilities — every one of the 13,460 facilities listed — found 1,097 that accept private health insurance while accepting no Medicaid, no Medicare, no state-financed plan, no sliding fee scale, and no payment assistance of any kind. If you do not hold employer-sponsored or marketplace coverage, these facilities have no route to admit you other than paying the full price yourself.
What we found 1,097 — facilities accept private insurance only, with no public coverage and no financial assistance 540 — of them offer residential treatment, the most expensive level of care 463 — provide medically supervised withdrawal management 83% — are private for-profit organizations |
How we narrowed 13,460 facilities down to 1,097
SAMHSA asks every facility in its annual survey which forms of payment it accepts. The options include Medicaid, Medicare, state-financed insurance other than Medicaid, private health insurance, federal military insurance, cash or self-payment, and various government funding streams. Facilities separately report whether they offer a sliding fee scale or payment assistance.
Most facilities accept a broad mix. Nationally, 79.4% take Medicaid and 79.5% take private insurance, almost identical figures that suggest an evenly accessible system. That impression does not survive a closer look.
From the full directory to the private-pay tier
| All facilities in the 2025 national directory — 13,460 | |
| Accept private insurance but no Medicaid, Medicare or state plan — 1,290 (9.6%) | |
| And offer no sliding fee scale and no payment assistance — 1,097 (8.2%) | |
| And receive no federal, state or block grant funding either — 849 (6.3%) | |
Bar lengths are proportional to facility counts. Source: SAMHSA National Directory of Drug and Alcohol Use Treatment Facilities, 2025 edition.
Ownership explains almost all of it
The gap between for-profit and non-profit facilities is not marginal. On every measure of financial accessibility, the two groups behave like different industries.
For-profit vs non-profit facilities
| Sliding fee scale, for-profit — 22.4% | |
| Sliding fee scale, non-profit — 51.2% | |
| Payment assistance, for-profit — 8.2% | |
| Payment assistance, non-profit — 30.8% | |
| Private insurance only, for-profit — 18.9% | |
| Private insurance only, non-profit — 2.2% | |
Percentages are of all facilities in each ownership category. Source: SAMHSA, 2025.
The sharpest number in the dataset 43.3% of for-profit residential facilities accept private insurance and no public coverage. Among non-profit residential facilities, the figure is 3.9%. That is an eleven-fold difference in the likelihood that a residential program will turn away someone whose only coverage is public. |
Where the private-pay tier is concentrated
These facilities are not spread evenly. Two states account for nearly half of the national total, and in both of them the residential figures are considerably worse than the statewide average.
Share of residential facilities accepting private insurance only
| California — 46.2% | |
| Florida — 43.6% | |
| Texas — 36.0% | |
| Utah — 30.4% | |
| New Jersey — 27.6% | |
| Colorado — 27.3% | |
| Tennessee — 24.2% | |
| Nevada — 23.3% | |
| Arizona — 20.2% | |
| Georgia — 18.2% | |
States with at least 25 residential facilities. Source: SAMHSA, 2025.
California alone holds 335 private-insurance-only facilities of the 1,290 nationally. Of its 517 residential programs, 239 accept private coverage and nothing public. Florida contributes another 147, with 71 of its 163 residential programs in the same position. Anyone researching treatment options in California or facilities across Florida is searching in the two markets where the private-pay tier is densest.
Withdrawal management is where it matters most
Of the 2,683 facilities offering medically supervised withdrawal management, 19.1% accept private insurance only, and just 28.6% offer a sliding fee scale. This is the level of care with the least tolerance for delay. Someone who needs supervised withdrawal from alcohol or benzodiazepines faces a genuine medical risk if admission is postponed while they arrange funding.
What the private-pay tier does accept Among the 1,290 private-insurance-only facilities, 86.3% accept cash or self-payment and 41.9% accept federal military insurance. Only 13.7% offer a sliding fee scale, and 3.4% offer payment assistance. The pattern is consistent: these facilities are equipped to bill a commercial payer or take payment directly from the person seeking care. What they are not set up to do is reduce the price. |
What this does and does not show
A facility declining Medicaid is not necessarily excluding people on purpose. Medicaid reimbursement rates for substance use disorder treatment are set state by state, and in several states they sit well below the cost of delivering residential care. Some facilities decline because the rate does not cover the bed. Others never sought certification. The directory records the outcome, not the reason.
Two further limits are worth stating plainly. The directory contains only facilities that responded to the 2024 survey and were approved for inclusion by their state substance use agency, so it is not a complete census of everything operating in the United States. And every field is self-reported by the facility, which means a program may accept a payer it did not record, or record one it no longer takes.
What the data does establish is a structural division. Roughly one in twelve treatment facilities in the country, and close to one in five residential programs, is reachable only by people who arrive with commercial insurance or the ability to pay in full.
If you are looking for treatment now
Ask about payment before you ask about anything else. A facility website may list insurance logos without specifying which plans it is in network with, and admissions teams are generally able to answer the question directly on a first call. Our coverage checker and out-of-pocket estimator can give you a figure to work from before you dial.
If you have Medicaid, ask specifically whether the facility is Medicaid certified rather than whether it accepts insurance. If you are uninsured, ask whether the facility offers a sliding fee scale, payment assistance, or state block grant funded beds. These are three separate things and a facility may offer one without the others. Every state also operates a single state agency responsible for publicly funded treatment, which can direct you to programs with no-cost or reduced-cost admission. California residents can start with our guide to free and state-funded recovery resources in California.
For more on what different levels of care typically cost, see our tool to compare costs across levels of care and our rehab payment options finder. Facilities carrying our verified badge have had their credentials independently checked.
If you or someone you know needs help finding treatment, SAMHSA’s National Helpline is free, confidential, and available 24 hours a day at 1-800-662-4357. |
Methodology
We downloaded the complete 2025 National Directory of Drug and Alcohol Use Treatment Facilities published by the Substance Abuse and Mental Health Services Administration, containing 13,460 facilities across all fifty states, the District of Columbia and five territories. The directory reflects facility responses to the 2024 National Substance Use and Mental Health Services Survey. We parsed each facility service code string and classified a facility as private-insurance-only where it carries the code for private health insurance but none of the codes for Medicaid, Medicare, or state-financed health insurance other than Medicaid. We then applied a second filter for the absence of both a sliding fee scale and payment assistance. Residential classification includes all four residential service settings recorded in the survey. Ownership categories are as reported by the facility. State-level residential figures are reported only for states with at least 25 residential facilities.
References
- Substance Abuse and Mental Health Services Administration. National Directory of Drug and Alcohol Use Treatment Facilities, 2025. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA.
- Substance Abuse and Mental Health Services Administration. National Substance Use and Mental Health Services Survey (N-SUMHSS): 2024 Data on Substance Use and Mental Health Treatment Facilities. Rockville, MD: SAMHSA, 2025.
- King C, Beetham T, Smith N, Englander H, Brown P, Hadland S, Bagley S, Wright O, Korthuis T, Cook R. Adolescent Residential Addiction Treatment In The US: Uneven Access, Wait Lists, And High Costs. Health Affairs. 2024;43(1). doi:10.1377/hlthaff.2023.00777
- National Institute on Drug Abuse. Words Matter: Preferred Language for Talking About Addiction. Bethesda, MD: NIDA.
