The ACA’s transformation of substance use treatment

In Health Affairs, Jeffrey Buck argues that the ACA will fundamentally transform substance use treatment.

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and standalone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered.

A few details:

  • Beginning in 2014, mental health services under Medicare will be subject to the same level of cost sharing as other Part B services, 20%, not 50% as it has been in the past. This change isn’t due to the ACA but to MIPPA (2008).
  • CHIP reauthorization in 2009 extends mental health parity to that program.
  • The ACA mandates that substance use treatment be included among mandated benefits.
  • Mental-physical health parity provisions extend to exchange plans and to Medicaid expansion.
  • The “whole-person orientation” of care delivery, included patient centered medical homes, will increase attention to and coordination of substance use treatment.
  • Medicaid will not be denied to individuals with incomes below 133% of poverty even if their only condition is substance use disorder. This is in contrast to prior law that barred such individuals from SSI and SSDI, which has been one route to Medicaid.
  • Medicaid expansion will double the number of non-elderly adults in that program with behavioral health disorders. Many will likely have substance use disorders too.
  • The shift in funding from a patchwork of state- and local-level sources to federal will encourage modernization and integration of substance use treatment.

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