The national trade organization representing addiction treatment providers is concerned that the Trump administration’s proposed changes in the Affordable Care Act will severely reduce coverage for treatment services.
On Tuesday, the National Association of Addiction Treatment Providers (NAATP) issued a statement on the administration’s “surprise move” announcing proposed changes in how states may comply with the “10 essential benefits” requirement contained in the Affordable Care Act (ACA). Medicaid coverage for mental health and addiction services is one of those essential benefits.
Beginning in 2019, the proposal would allow states to use another state’s essential health benefit plan as its benchmark. States could make these changes on an annual basis and change which state’s plans they chose to emulate.
States could also shop for the most flexible plan within the 10 essential benefits, according to the NAATP. For example, a state could use another state’s benchmark for prescription drugs and a different state’s plan for hospitalization.
“What this means for National Association of Addiction Treatment Providers members is unclear because it would depend on how each state utilizes the flexibility,” says Mark Dunn, NAATP’s director of public policy. “States could decide to leave treatment for Substance Use Disorder (SUD) alone. Or they could decide to use a benchmark from another state, which is more limited.”
The NAATP says it “will continue to analyze this proposal, make appropriate comments and keep our members informed regarding the potential consequences. NAATP has consistently held the view that SUD should be maintained as an essential benefit.”
The Republican proposal to replace the Affordable Care Act, announced earlier this year, would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans. The proposal would also roll back the Medicaid expansion under Obamacare. Thirty-one states and the District of Columbia expanded Medicaid under the ACA.
“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Bloomberg School of Public Health, told the Washington Post.
Nearly 1.3 million people receive treatment for mental-health and substance abuse disorders under the Medicaid expansion, according to an estimate by health care economists Richard G. Frank of the Harvard Medical School and Sherry Glied of New York University.
In a blog post on Thehill.com., Frank and Glied said removing the behavioral health provisions in the ACA “would have stark effects on those with behavioral health illnesses. We estimate that approximately 1,253,000 people with serious mental disorders and about 2.8 million Americans with a substance use disorder, of whom about 222,000 have an opioid disorder, would lose some or all of their insurance coverage.”
Repealing the mental and substance use disorder coverage provisions of the ACA would withdraw at least $5.5 billion annually from the treatment of low income people with mental and substance use disorders, Frank and Glied wrote.
Frank and Glied also noted that several states — Kentucky, Massachusetts, Maryland, Ohio and West Virginia — have addressed the opioid overdose problem by promoting use of effective Medication Assisted Treatment (MAT) as part of their Medicaid expansions. As a result, Medicaid pays for between 35 and 50 percent of all MAT in those states.
“It would be a cruel sham for Congress to take an important, but modest, step forward in investing in treatment capacity, while withdrawing funds from the enormous recent progress made in addressing the needs for care of those with mental health and addictive illnesses,” Frank and Glied wrote.