Major Disparities in Medicaid Coverage of Addiction Treatment Across US States

By Kelly Burch 12/08/16

Despite the Affordable Care Act requiring all states to cover treatments for addiction, some states will not foot the bill for inpatient care.

Study Finds Major Disparities in Medicaid Coverage of Addiction Treatment Across US States

Medicaid coverage of addiction treatment varies drastically from state to state, even among those that have expanded coverage under the Affordable Care Act, according to a study published this week in the journal Health Affairs

States that expanded Medicaid under the ACA were required to include treatment for addiction. However, the individual states got to decide which of the four levels of treatment they were willing to cover: outpatient (including group and individual therapy); intensive outpatient; inpatient or intensive inpatient for detox. 

Researchers looking at data from 2014 found that 13 states and Washington, D.C. covered services in all levels, according to a report by Kaiser Health News. Twenty-six states covered at least one service at all four levels. Nine states did not provide any options for care at two of the levels. In most of these cases, states would not pay for inpatient care, which has traditionally been difficult to get insurance providers to cover. 

The expansion of Medicaid allowed more people to access treatment. In Massachusetts, for example, 63,000 people received treatment between January 2015 and March 2016. Because of that, Colleen Grogan, the lead author of the study, said that repealing expanded Medicaid coverage—as President-elect Trump says he plans to do—would be disastrous. 

“If we repeal the ACA, I think that’s going to make it worse,” Grogan said. “It’s really hard to address the epidemic if you can’t get people connected to services.”

The study also examined which treatment medications state insurance programs would cover. All states covered buprenorphine and all but two states covered injectable naltrexone. Only 32 covered methadone, one of the most effective drugs for medication-assisted treatment. Yet even when the medications were covered they could be hard to access because of barriers like the requirement of pre-authorization or co-pays that many people newly in recovery might have trouble affording. 

However, Grogan was encouraged by the widespread coverage of medications that assist in obtaining and maintaining sobriety. “We’ve moved quite a ways in accepting that medication for the rest of your life is needed,” Grogan said. 

Although addictions services are expensive, Grogan said that allowing people to languish in active addition without these services has a high financial, social and moral cost. 

“I think even from a moral perspective, we know that we need to respond to people who have addiction,” Grogan said. “Especially for those that have reached a point that want help.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.