The Affordable Care Act seems like a boon for addiction treatment centers because it allows states to expand Medicaid to many more low-income people, meaning that drug addicts and alcoholics who were previously ineligible could now receive coverage for substance abuse treatment, which the law has deemed an “essential health benefit.” The New York Times says there is a hitch: Under an federal rule enacted almost 50 years ago, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds. Many centers typically are larger than 16 beds.
The quirk in the law could have a significant impact on substance abuse treatment in the 26 states that have expanded Medicaid under the health care law. While millions of low-income addicts have been promised access to treatment through the expansion, the rule will most likely prevent many from entering residential programs, a more intensive form of care, even as heroin addiction is surging in many states. “For some addicts, there is an undeniable and essential need for residential treatment,” said Allen Sandusky of the South Suburban Council on Alcoholism and Substance Abuse near Chicago “The ACA is going to mess that up badly unless this problem is acknowledged and addressed.”