A Flawed System: Medicaid Treatment for Addicts

Medicaid Treatment For Addicts Promises A Great System

America’s Medicaid program, since its creation, has acknowledged the rising problem of drug addiction in America. In an attempt to offer a cheap insurance solution, Medicaid expanded to include the low income, federal health Affordable Care Act (ACA) in 31 states and the district of Columbia The ACA seems great at first, offering a lot promise to substance abusers who lacked the necessary finances to support their rehab.

Medicaid says that those states that choose to expand their Medicaid can only do so if they include a mandatory regimen to treat drug addiction. The ACA states that care for addiction and substance-related problems must be completed as meticulously as any other medical procedure. Things included in the ACA’s insurance policies include:

  1. Addiction Evaluation to identify the current level of a substance abuser’s problem and further understand what change must be done.
  2. Brief Interventions to help stop people exhibiting risky behavior before they develop addictions .
  3. Alcohol and drug testing
  4. Family counseling
  5. Visits to clinics
  6. Addiction recovery medication such as Clonidine, to help with opiate withdrawals.
  7. Anti-craving medication like Acamprosate, used to eliminate cravings for alcohol.
  8. Health visits at home

All great things and often necessary if one hopes to successfully curb their substance abuse problems.  Not only are these good treatment supports, but the ACA’s insurance plans can cover an extensive amount of the cost of these services.

  • Bronze Plans cover 60% of expenses.
  • Silver Plans cover 70% of expenses.
  • Gold Plans cover 80% of expenses.
  • Platinum Plans cover 90% of expenses.
  • Catastrophic Plans, available only to those under 30, cover an average of 60% of expenses.

Medicaid Is Not Fairly Regulated Across The States

Everything about the ACA seemed great at this point, but a study done in 2014 (when only 21 countries had expanded Medicaid) unearthed some inequalities in the system. Since Medicaid allowed states to choose the types of treatment and medication that would be covered, not every state had identical coverage for those seeking rehab. After extensively gathering data on recovery facilities in the States, a study performed by HealthAffairs concluded that the rate of expansion didn’t properly balance with the coverage being issued.

  • Thirteen states, and the District of Columbia, had all levels of substance abuse treatment fully covered – inpatient detox, outpatient detox, outpatient treatment, intensive outpatient treatment, inpatient rehab treatment, and medication assisted treatment.
  • At least one service for each level of treatment was covered in 26 states.
  • Nine states offer no Medicaid reimbursement for at least two tiers of addictions service.

The funding of Medicaid opened the door to a lot of financially ill addicts to seek support, but beyond that door lay a lot of complications and discrepancies among different states.

Medicaid’s Delivery System For Addiction Support Differs State-To-State

Medicaid programs may be delivered in different ways in different states. There are three main ways that Medicaid uses as a basis to deliver substance abuse treatments, and they’re important to understand to help address the imbalances in the Medicaid addiction treatment program across the country.

  1. Fee-For-Service: The state manages addiction treatment separately from other programs that may be included in care, on a fee-for-service basis.
  2. Managed care, with no carve-out: In this instance, the physical health Managed Care Organization is solely responsible for any substance abuse services.
  3. Managed care, with carve-out to a managed behavioral health organization (MBHO): Services for substance abusers are carved-out from fee-for-service or a Managed Care Organization, and delivered by a MHBO.

Medicaid’s Affordable Care Act Is Flawed Beneath The Surface

While the ACA may have opened up access to treatment for the impoverished, and signifies that America is gradually moving towards accepting substance abuse disorders as manageable afflictions that can be treated, it was not without its problems. When financially unstable addicts finally reached out for those treatments, many were dismayed to find themselves being attacked with extra fees or charges.

Under the ACA, struggling substance abusers found themselves faced with more struggle once they reached out for help. Many treatment centers required preauthorization for inpatient rehab or acceptance onto a medicated maintenance facility, leaving the addict to suffer without treatment until the authorization has passed. Other facilities demanded that patients pay a portion of the treatment supposedly covered, while others imposed annual maximums on coverage that left people helpless with incomplete recoveries.

Half the states imposed preauthorization on patients applying for inpatient rehabilitation, leaving them to suffer at the whim of withdrawal or severe addictions for even longer without support. Almost every state required preauthorization for opiate addicts seeking medicated opioid replacement therapy. The fear of withdrawal is what drives substance abusers to crime – they would rather run the risk of jailtime than fight off their withdrawals another day. When finally desperate enough to seek rehabilitation, the last thing an addict wants to hear is that they must wait even longer before they can be helped.

Medicaid In Different States Delivers Affordable Care Differently

While the ACA seemed great at first, as its inner workings began to be understood, it became clear that not everyone in the States was getting equal treatment. The different methods of delivery meant that different populations were paying different fees for the same treatment.

HealthAffairs also uncovered the details about which states provided which kinds of treatment for substance abusers, and found that almost all of them are reliant on one of Medicaid’s managed care delivery systems.

  • 21 states that provide residential treatment.
  • Of these 21 states, 11 utilize a managed care organization, three utilize a MBHO, and seven operate on a fee-for-service basis.
  • There are 48 states that provide outpatient treatment services for addicts.
  • Of the states providing outpatient support, 19 use a managed care organization, 13 use a MBHO, and the other 19 states operate on a fee-for-service basis for outpatient support.
  • All 50 states cover medication for maintaining substance addictions.
  • Only two states, California and Michigan, use a carve-out for these medications.  Medication for substance abuse treatment in every other state is included on an individual’s general pharmacy benefit, which is further separated into states who use managed care organizations or operate on a fee-for-service basis.

Medicaid has helped a lot of people, but it’s also caused a lot of stress. Hopefully, your state has reasonable insurance policies.

SOURCES:

http://khn.org/news/medicaid-coverage-for-addiction-treatment-varies-dramatically/

http://content.healthaffairs.org/content/35/12/2289.abstract

https://www.medicaid.gov/

https://www.openminds.com/market-intelligence/executive-briefings/integration-medicaid-addiction-treatment-services/

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By |2017-03-23T17:01:16+00:00January 25th, 2017|

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Northpoint Recovery
Northpoint Recovery is the premier drug and alcohol rehab, detox, and treatment facility in the Northwestern United States.

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