Advocacy Group: Educate State Lawmakers About Benefits of Addiction Coverage

The U.S. Supreme Court’s decision last month on the Affordable Care Act is a victory for people with substance use disorder and mental health needs, according to the Legal Action Center, an advocacy group that provides legal assistance to people in recovery or still suffering from addiction. But much work remains to be done at the state level to assure adequate coverage, the group says.

The decision upheld all of the provisions that require inclusion of substance use disorder and mental health coverage at the same level as other essential health benefits that insurers must cover, according to the Center.

“Overall, we are very pleased with the ruling, and excited to move forward in working with policymakers and advocates to ensure that the law is well implemented for people with substance use disorder and mental health needs,” said Gabrielle de la Gueronniere, JD, Director for National Policy.

The statute requires that substance use disorder and mental health services must be provided through the health insurance exchanges being set up throughout the country, as well as in certain other small and individual private health plans that are outside of the exchanges, de la Gueronniere says. “This will really increase access to care in private insurance plans,” she adds.

The Medicaid population will also have expanded access to these services, which must be at parity with coverage for other illnesses. Because the court ruled that the federal government cannot force states to expand their Medicaid coverage, some states have indicated they are unsure if they will move forward with the expansion, de la Gueronniere notes. “We certainly are concerned about this. But we are very much hoping that states will take advantage of the expansion, which will be fully funded by the federal government for the first three years, and funded at 90 percent after that,” she adds.

The provider community is anxious for states to expand Medicaid, and that is likely to increase as they see a growing number of patients who are eligible for Medicaid come into their programs, she observes. “We know the cost of untreated addiction and mental illness is significant,” she says. “We hope to educate policymakers on the huge opportunities that increasing coverage will bring, and how increasing access to these services will ultimately reduce costs to their systems.”

The Affordable Care Act requires that health insurance plans sold to individuals and small businesses provide a minimum package of services called “essential health benefits.” Instead of establishing a national standard for these benefits, the Department of Health and Human Services is allowing each state to choose from a set of plans to serve as the benchmark plan in their state. States are now working to define their “essential health benefits” packages, and must complete that process by the end of September. That means levels of coverage for addiction and mental health services could potentially vary by state, according to de la Gueronniere. Whatever level of service for addiction and mental health coverage a state chooses, however, must be comparable to that of other chronic diseases.

“We’ve heard concern from advocates that some states have not been moving forward quickly to implement the federal law,” she says. “We want to emphasize that there is still time for advocates in the addiction and mental health field to help educate policymakers about the need for robust addiction and mental health services.”