What do the new health care laws mean for addiction treatment?
In 2014, major portions of the Affordable Care Act (also known as ACA or Obamacare) and the Mental Health Parity and Addiction Equity Act (MHPAEA) will go into effect, ushering in some changes for how addiction treatment is covered.
One of the biggest changes impacting addiction treatment is that the ACA will allow more people to be covered by health insurance obtained through private health plans sold in the new state marketplaces. Additionally, 26 states at this time have chosen to expand their Medicaid programs, including mental health and addiction treatment, to people who didn’t qualify in the past. This means that more people will have coverage.
The ACA also requires certain newer health plans to make the following changes:
- Offer addiction and mental health benefits as part of the “essential health benefits,” which are a set of minimum health care service categories
- Stop limiting how much insurers will pay each year, and over a lifetime, for care provided as part of these essential health benefits
- Cover preventive services, such as screening and counseling for risky drinking and tobacco use, without cost to the patient
The MHPAEA requires that if a health plan offers addiction treatment benefits, the plan must offer coverage at the same level as coverage for medical and surgical benefits. For example, a health plan can’t require a copay for a visit to an addiction treatment provider that is higher than the copay charged for most medical specialists. Nor can a plan require patients to get office visits pre-approved more often than it requires pre-approval for other medical visits. Also, plans have to offer a range of addiction and mental health benefits that are similar to the range of medical and surgical benefits offered.
What Does this Really Mean?
While these new rules are a step in the right direction, they still fall short. Because the new laws vary from state to state, not all who need this important coverage will receive it. Also, several types of health plans aren’t subject to either the ACA or MHPAEA, meaning they don’t have to amend how they approach addiction treatment. More work is needed to ensure that addiction is treated as regularly and as effectively as other health conditions.
Click here for CASAColumbia’s recommendations for addiction prevention and treatment benefits that should be included in health insurance plans.