[Photo: Armando L. Sanchez for the New York Times]
On its surface, the Affordable Care Act seems like a boon for addiction treatment centers like the South Suburban Council on Alcoholism and Substance Abuse, housed in a no-frills former hotel outside Chicago.
The law allowed 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.”
But there is a hitch: Under an obscure federal rule enacted almost 50 years ago, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds. The South Suburban Council’s main treatment program has 48. So the very people who might have flowed through its doors in search of care will not be coming. And the same problem faces many other centers, which typically are larger than 16 beds, experts say.
The quirk in the law could have a significant impact on substance abuse treatment in Illinois and the 25 other 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.
www.nytimes.com/2014/07/11/health/obamacare-substance-abuse-treatment-hurdles.html
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