ACA Coverage for Prescription Drug Addiction Treatment

Since its rollout in 2008, the Affordable Care Act (ACA) – also known as Obamacare – has had to overcome a number of hurdles.

One of the first is the infamously problematic rollout of website signup.

The ACA has also faced a number of legal challenges, managing to retain its footing through all of them.

ACA ruling by SCOTUS June 2015 Time magazine

Most recently, the U.S. Supreme Court reinforced the legal status of ACA reimbursements in all 50 states, whether or not a statewide health insurance exchange exists.

As a result, millions of Americans now enjoy better and more affordable healthcare coverage and a wider variety of coverage options.

Some of the most notable new benefits go to drug addicts, who now receive health insurance coverage for recovery from addiction to prescription drugs like Adderall and Xanax at the same level as other forms of medical care.

The New Drug Addiction Treatment Mandate

The new mandate dictates that, starting form 2014, eligible adults suffering from substance use disorders can receive treatment coverage from Medicaid and any health insurance on the Health Insurance Exchanges.

Currently, health insurance must cover 10 essential health categories. These include hospitalization, ambulatory services, laboratory services and emergency services among others. Included in this list is the category, mental health and substance use disorder services.

This means that treatment for drug addiction is now an essential health issue that must be covered by all health insurance plans in the marketplace.

Various agencies have been slowly releasing statements regarding what is covered vs. not covered. For example, in July 2014, Medicaid issued a detailed bulletin noting which types of Medication-Assisted Treatment and Behavioral Treatment services should be covered by state Medicaid plans.

Parity Protections

To further cement its place on the essential health categories list, mental health and substance use disorder services are granted parity protection under the ACA.

This means that any financial or treatment limits placed on substance abuse and mental health care should not be more restrictive than those applied to categories in regular medical care such as hospitalization.

Basically, coverage of drug addiction must be provided at the same level as regular physical care.

Parity protections address limits such as deductibles, out of pocket payments, co-insurance and number of visits covered.

What This Means For Drug Use Disorder Patients

3 ways ACA helps drug rehabPrior to ACA, there was no coverage for addiction treatment for those without insurance. If one could not afford expensive private health insurance, he or she had nowhere else to turn.

In the end, less fortunate people would end up being absorbed by the criminal justice system where they could at least get some help. Unfortunately, the penal system isn’t the best place to be treated for substance abuse, and most addicts remain addicted when released.

The Affordable Care Act now recognizes drug use disorder (drug addiction) as a disease, one that requires treatment.

Including it as a must-cover for all ACA approved healthcare insurance plans provides drug addicts with an opportunity to seek medical treatment among other care services.

The impact of this mandate is far reaching. It improves the general health of the population, saves the country money, improves productivity at work, improves the state of families and reduces the burden on the criminal justice system.

Addiction Recovery Services Offered By ACA

Due to parity protections, drug addiction coverage will be pretty much like any other disease.

Patients can receive preventive care, take advantage of early intervention programs and choose from Medically-Assisted Treatment and Behavioral Treatment programs.

Other services that must be provided to every community include:

• Medical screenings
• Educational campaigns
• Community prevention activities and programs

Known Limitations

As of now, it is not exactly clear which specific substance abuse services will be covered under the new mandate.

The Department of Health and Human Services is still in the process of determining what services to cover.

For example, abuse of certain prescription drugs such as methadone & Naloxone is not covered.

Other restrictions vary depending on the state.

  • In Alaska, treatment in residential treatment centers is not covered. Neither are day treatment services.
  • In Colorado, coverage is limited to a total of 35 visits per year for all forms of substance abuse.
  • In Mississippi, only abuse of FDA approved prescription drugs is covered.
  • In South Carolina and Nebraska, treatment is only covered in facilities approved by the state.

In general, the legislative journey for drug addiction coverage under ACA has a way to go.

But this is a positive start, and many substance abuse victims have already started enjoying the benefits.

Summary

Among the many achievements of the Affordable Care Act, recognition and coverage of substance abuse as a disease will be one of the biggest.

Those who will be benefit most are low income patients who previously could not get help.

Hopefully, ACA will improve to remove any existing restrictions on services provided to drug addicts.

References

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