Medicaid Benefits For Addiction Treatment Expanded After Implementation Of The Affordable Care Act

Abstract

The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Columbia regarding their addiction treatment benefits and utilization controls in standard and alternative benefit plans in 2014 and 2017, when plans were subject to ACA parity requirements. The number of state plans that provided benefits for residential treatment and opioid use disorder medications increased substantially. States imposing annual service limits on outpatient addiction treatment decreased by over 50 percent. Fewer states required preauthorization for services, with the largest reductions for medications treating opioid use disorder. The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans. This trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.

Keywords: Health Reform; Medicaid; Mental Health/Substance Abuse.

EXHIBIT 1. Number of standard Medicaid plans reporting benefits for selected addiction treatment services and medications, 2014 and 2017

EXHIBIT 2. Number of Medicaid alternative benefit plans reporting benefits for selected addiction treatment services and medications, 2014 and 2017

EXHIBIT 3. Percent of addiction treatment services and medications subject to selected utilization controls, by plan type, 2014 and 2017