Provision in Medicaid Can Restrict Access to Addiction Treatment under ACA

ACA printed on piece of paper over money.

Old Law Hinders New Addiction Treatment Directive

A 50-year-old Medicaid provision could severely impact many low-income patients looking for addiction treatment. Although the Affordable Care Act was forecasted to improve access to addiction and mental health services, a rule established by Medicaid decades ago says that the program will only cover community-based residential programs with 16 beds or fewer. Many facilities are being forced to downsize because of the unforeseen glitch in the law, which was highlighted in a recent article. 26 states have expanded Medicaid under the Affordable Care Act, meaning residents can find themselves priced out of quality treatment for drug and alcohol addiction.

Cost vs. Survival

The article also discusses the alarming heroin surge throughout the United States and how millions of lower-income patients can be left without the care they were promised. In California, 90% of addiction treatment centers are too large for Medicaid reimbursement. According to the article, the rule was written to prevent Medicaid funds from going to in-state psychiatric hospitals. Addiction care experts and prevention advocates are hoping the issue is addressed, citing a definitive and absolute need for many low-income patients to enter some form of residential treatment. It would take an act of Congress to make any changes to the legislation. 

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