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Edition 10, April 2014—Article Highlights
Substance Abuse and the Affordable Care Act
The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.
 
 
Required Access to Substance Use Disorder Treatment
The Affordable Care Act (ACA) includes many provisions to improve and expand treatment for people with substance use disorders. Some of these include:
  • Requires states to cover Substance Use Disorder treatment for all newly eligible for Medicaid
  • Includes Substance Use Disorder treatment as part of “essential health benefits” package offered in state Exchanges
  • Encourages collaboration between mental health providers and physical health providers
  • Requires Substance Use Disorder screening without a copay
 
 
Health Care Reform, Medicaid Expansion and Access to Alcohol/Drug Treatment
  • The Medicaid expansion population will have relatively high rates of alcohol/drug problems
  • Up to 53% of some populations will need alcohol or drug treatment
  • Untreated substance abuse is a key driver of chronic physical disease progression
 
 
Medicaid Expansion Opportunities & Risks
– Behavioral Health Care
Medicaid members have higher overall behavioral and substance abuse costs in aggregate versus a Commercial population. For certain utilization categories, such as IP Hospitalization, the costs can be nearly 10x larger in a Medicaid population.
 
 
 
 
 
 


 

 

 
 
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