Affordable Care Act to Provide Substance Abuse Treatment to Millions of New Patients

The Affordable Care Act (ACA) will revolutionize the field of substance abuse treatment, according to A. Thomas McLellan, PhD, CEO and co-founder of the Treatment Research Institute.

“It will have more far-reaching positive consequences for substance abuse treatment than anything in my lifetime, including the discovery of methadone,” he said at the recent annual meeting of the New York Society of Addiction Medicine. “It will integrate substance abuse treatment into the rest of health care.”

Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction, said Dr. McLellan, who is a former Deputy Director of the White House Office of National Drug Control Policy. Most who receive treatment are severely affected, he said.

“If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage,” he said.

A. Thomas McLellan, PhD

Dr. McLellan reported that 23 million American adults suffer from substance abuse or dependence—about the same number of adults who have diabetes. An additional 60 million people engage in “medically harmful” substance use, such as a woman whose two daily glasses of wine fuels growth of her breast cancer. The new law will allow millions more people to receive treatment, including those whose substance abuse is just emerging.

Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention. Substance abuse treatment will also be considered an “essential service,” meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse. “There will be more prevention, early intervention and treatment options,” he said. “The result will be better, and less expensive, outcomes.”

By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Government insurers (Medicare and Medicaid) will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.

Currently, federal benefits, such as Medicaid and Medicare, focus on inpatient services, like detox programs, but do not cover office visits for substance abuse treatments. In contrast, Medicaid covers 100 percent of diabetes-related physician visits, clinic visits and home health visits, as well as glucose tests, monitors and supplies, insulin and four other diabetes medications, foot and eye exams, and smoking cessation for diabetics. “These are all primary care prevention and management services, which are the most effective and cheapest way of managing illness,” he said.

The impact of these new rules will be quite substantial, since an estimated 65 percent of insured Americans are covered by Medicaid or Medicare, and the rest are covered by insurance companies that base their benefits structure on federal benefits, said Dr. McLellan.

As addiction becomes treated as a chronic illness, pharmaceutical companies will be much more interested in developing new medications, he added. “Immense markets are being created,” he said. “Until now, there have been about 13,000 treatment providers for substance use disorders, and less than half of those are doctors. Now, 550,000 primary care doctors, in addition to nurses who can prescribe medications, will be caring for these patients.”

150 Responses

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    Lisa Walsh

    August 29, 2017 at 5:38 PM

    So its August 2017 I’ve been clean and sober 100% for two year’s this December 2017 With the help of methadone! I have Finallyyyy been able to live productively.I’m 46 yrs old and Its been a long road.Anyhow due to some personal extenuating circumstances I’m up and moving to Waycross Georgia from Syracuse Ny.Here in Syracuse Medicaid covers 100% of mmat.Apparently Waycross DOESN’T accept ANY FORM OF MEDICAID OR ANY OTHER INSURANCES.IT’S $15./DAY..I’M DISABLED ON SSI.IF I PAID OUT OF POCKET THAT MUCH I DON’T KNOW HOW I COULD SURVIVE.THAT WOULD BE 80% of my income.I THOUGHT THE AFFORDABLE CARE ACT COVERED MMAT! DOES ANYONE KNOW ANY LOOP HOLES OR ANYTHING? Otherwise i may have to make a CHOICE live here unsafely or there broke! IT JUST DOESN’T MAKE SENSE.I COULD SEE A SLIDING SCALE BUT TELLING EVERYONE IT’S THE SAME AMOUNT $15. A day across the board!! HELP ANYONE KNOW ANYTHING I COULD DO OR HELP WITH GETTING SOME HELP WITH THE FEE! UGHHHH

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      August 30, 2017 at 4:51 PM

      Hi Lisa,
      First, let me say how wonderful it is that you have found your way to recovery. It’s so great to hear success stories.

      That said, I’m so sorry that you are struggling with getting coverage for treatment. I know Medicaid coverage is very state dependent. It might help to contact your local department of health and human services to see what they suggest. It might also help to contact local substance use treatment programs to see if they have any ideas as to how this can be funded.

      I will keep checking on my end to see if there is anything else we can suggest. I can only imagine how frustrating this is and wanted you to know that we got your post and are looking into it.

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        Lisa Walsh

        August 30, 2017 at 7:35 PM

        Thank you Pat! I appreciate your quick and timely response! Any information you can provide would be immensely appreciated!!

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          August 31, 2017 at 4:36 PM

          Hi Lisa,
          One of my colleagues at the Partnership was able to uncover this information:

          I spoke with 3 treatment centers in Savannah. There is no state policy blocking Medicaid payments for MMAT. Two of the places do accept Medicaid for methadone maintenance.. it is on a case by case basis. I was unable to reach the one place listed in Waycross to confirm Lisa’s understanding. It is a 2 hour drive from Waycross to Savannah. The SAMHSA Treatment Locator operator said Jacksonville, FL was closest center. GA does have a Crisis and Access Helpline.. 800-715-4225. I spoke with them at length .. good people. They referred me to Coastal Community Behavioral Health Center in Kingsland, GA, roughly 50 miles from Waycross. Bottom line, Lisa must call them herself and speak with one of their clinicians.

          I hope this helps!

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    March 18, 2017 at 7:53 PM

    hope all went well with your d yes it is true you must test positive for the drug of choice/heroin./opioids

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    October 30, 2016 at 6:16 PM

    i’m preparing to do an assessment tomorrow in order to be admitted to a detox facility that accepts medicaid. as i understand it there are a few steps to this process but one of my major concerns is that i have heard that in order to be accepted to the program you actually have to test positive for the drug for which you are to be treated. in my case this is heroin – so am i actually expected to test positive for heroin in order to be accepted into the program? i know this seems counterproductive but i wouldn’t be surprised if this were true, as at some level a positive test result for the drug in questions does serve to verify the claims of someone seeking admission to such a program. if anyone has any information on this i would really appreciate your input. thanks in advance.

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    October 19, 2016 at 11:49 PM

    methadone saved my life

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      Lisa Walsh

      August 30, 2017 at 7:45 PM

      Mine too! After using opiates and being a a iv heroin addict for 30+ years with treatment AND Methadone maintenance I’ve been clean almost 2 year’s! The longest I’ve ever been WITH the HELP of mmat!!! I like to reiterate It’s ONLY a tool though ! You must change your lifestyle..People,Places and things….Etc As in my opinion Drug use is ONLY a symptom of the problem! We have to get to that underlying root of what is going on with us! Addiction is a dis-ease.
      So that’s why i say for me it’s a “tool” in this fight ! However it has definitely been life saving along with CHANGING other areas of my life! I’m TRULY a grateful recovering addict,named Lisa❤.

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