In 2015, almost 3 million Americans were addicted to opioids, including both prescription medications and street drugs like heroin. Treatment for more than 650,000 non-elderly adults for addiction comes from Medicaid, the largest single payer for substance abuse treatment. Every year, substance abuse treatment costs close to $34 billion, and Medicaid covers just over $7 billion of that.

Substance abuse treatment can cost over $10,000, and most people without insurance or with private insurance have trouble coming up with the costs or co-pays associated with drug rehabilitation. As a result, people who receive Medicaid are twice as likely as uninsured people to go through residential or outpatient substance abuse treatment.

Medicaid Expansion States Saw Decreases in Hospitalizations

With passage of the Affordable Care Act (ACA) in 2010, 32 states expanded access to Medicaid among residents earning up to 138 percent of the federal poverty level. In states that expanded Medicaid, the number of uninsured hospitalizations related to behavioral healthcare (including addiction) decreased significantly.

Half of states have above-average rates of opioid addiction and death rates related to addiction, and of these states, eight have not expanded Medicaid. Currently, around 441,000 non-elderly adults with opioid addiction are uninsured. Changes under the American Health Care Act (AHCA), which passed the US House of Representatives and is currently being debated in the Senate, could significantly raise the number of uninsured adults with addictions.

Private Insurers Rarely Offer Benefits Comparable to Medicaid

While private insurance policies under the current ACA must follow parity laws in coverage for mental health conditions, those policies can still result in up-front expenses that make it all but impossible for many insured adults with addictions to receive substance abuse treatment.

Many policies have high deductibles that must be paid before any insurance benefits become effective, and these deductibles are too high for many people to manage. As a result, many addicts do not pursue substance abuse treatment for economic reasons. Health policy experts and addiction treatment specialists worry that changes under the AHCA could put addiction out of reach of even more Americans.

Reversing Medicaid Expansion Under the American Health Care Act

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Federal legislators in states where Medicaid did undergo expansion are in some cases being pressured by their colleagues on Capitol Hill to accept AHCA provisions that roll back Medicaid expansion in their states. Since Medicaid expansion allowed around 150,000 Ohio residents and approximately 63,000 Pennsylvania residents to obtain addiction treatment, reversing Medicaid expansion would make substance abuse treatment impossible for tens, if not hundreds, of thousands of people. The eight states with higher-than-average opioid overdose death rates that have not expanded Medicaid can expect little relief under the AHCA.

Other Potentially Damaging Factors

In addition to potential rollbacks to Medicaid expansion, other provisions of the AHCA are expected to make addiction treatment more difficult, or even impossible, for many seeking substance abuse treatment. For example, if provisions allowing states to opt out of coverage for mental health and substance abuse treatment remain and the AHCA passes, insurers in many states will simply reduce or eliminate this type of coverage to save money. If states allow insurers to price plans based on pre-existing conditions (including drug addiction), many people will be priced out of the market for health insurance.

What Happens to Uninsured or Underinsured People with Addictions?

In parts of the country where local resources exist for treating drug addiction, funding frequently runs out, forcing local facilities to ration care. This may mean that once money for rehab runs out, people with addictions may be able to go through detox, but not rehabilitation. This makes addicts far likelier to resume their addiction and end up living on the streets, landing in jail, or dying. Medicaid expansion has allowed many facilities to expand their addiction treatment services and it has also created jobs. Repeal of the ACA and replacement with the AHCA is expected to reverse these trends.

Substance abuse treatment starts with detox, but it certainly does not end there. It is not easy to know what resources are available to you or your loved one in need of treatment, but speaking with an addiction treatment specialist is a good first step. If you would like to learn more about the options available for substance abuse treatment, we encourage you to contact us at any time.

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Exploring Medicaid’s Role in Substance Abuse Treatment
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