Release Date: Jul 8, 15, 12:00am

For immediate release
July 8, 2015
Contact: Julie Jung, 773.702.1168

ACA to Expand Help to People with Addictions

Improvements Possible if State Medicaid Programs Consider Lessons from Coverage of Mental Health Services

Millions of low-income people with alcohol, drug, and other addictions are now eligible for treatment assistance under Medicaid, due to provisions in the Affordable Care Act that came into effect in 2014.

Over time, the changes enacted under the ACA will make Medicaid the primary form of support for addiction services.  This could vastly improve help to people with addictions, especially if the addiction treatment system  follows the model of expansion under Medicaid pursued by the mental health system, write the authors of “Lessons from Medicaid's Divergent Path on Mental Health and Addiction Services” published in the current issue of the journal Health Affairs.

Colleen Grogan, professor at the University of Chicago School of Social Service Administration (SSA) presented the paper on Wednesday, July 8 at a forum organized by the journal at the National Press Club in Washington, DC.

The lead author is Christina Andrews, a 2012 PhD graduate of SSA, and an assistant professor in the College of Social Work, University of South Carolina in Columbia. The two are joined by Marianne Brennan, a doctoral student at SSA, and Harold Pollack, the Helen Ross Professor at SSA.

Drawing on their research, the authors point out that Medicaid’s expanded financing of mental health services led a number of improvements. From 1991 to 2009, Medicaid expenditures on mental health rose from about $10 billion a year to nearly $40 billion. This increase in spending corresponded to an expansion in the scope of mental health services covered by Medicaid, which provided important new opportunities for community-based treatment and support. 

Lessons from Medicaid’s impact on the mental health delivery system can provide a guide for creating a more flexible and effective addiction treatment system, the authors argue, by: “leveraging optional categories to tailor Medicaid to the unique needs of the addiction treatment system, providing incentives for addiction treatment programs to create and deliver high-quality alternatives to inpatient treatment, and using targeted Medicaid licensure standards to increase the quality of addiction services.”

While historically some money for addiction treatment has come from Medicaid, in 1996 Congress  disallowed addiction as a qualifying condition for federal disability programs, sharply curtailing  the role of Medicaid in this treatment system. The ACA, however, mandates Medicaid coverage for addiction treatment and allows states to expand eligibility to all citizens with incomes at or below 138 percent of the federal poverty level.

“Now active in twenty-nine states and the District of Columbia, the Medicaid expansion will increase enrollment by 10.7 million people. Medicaid spending for addiction treatment is expected to double from $5 billion to $12 billion by 2020, quickly making Medicaid the largest payer of addiction treatment in the country,” the authors said.

Stakeholders in addiction treatment could take advantage of the change by advocating for coverage across a continuum, from intensive outpatient treatment to recovery-oriented services to manage addiction as a chronic illness, the authors write.

Other improvements could include community-based alternatives to inpatient care and higher standards for treatment professionals. Medicaid regulations could require stricter credentialing, for example. “Less than half of addiction treatment providers have professional degrees and any formal training or credentialing in addiction treatment,” the authors point out.

The changes could also lead to better coordination between the mental health and addiction treatment systems. “These systems now face a common challenge to integrate with each other. Stakeholders across both systems recognize the high prevalence of co-occurring mental health and addiction disorders,” the paper says. 

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