The Affordable Care Act (ACA) that went into effect January 1, 2014, includes pre-existing conditions but effectively discriminates against addiction treatment for those with the lowest incomes. Evidently, an existing federal law prevents drug treatment centers, including hospitals, from helping Medicare patients if they have more than 16 beds! This outdated law originally was enacted to prevent Medicaid funding going to private institutions and from the “warehousing” of mental patients.
More than 23 million Americans needed treatment for an alcohol or drug problem in 2012 but only 11% received it, according to estimates from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
Many drug rehabilitation centers are reporting that they have had to turn away new Medicaid patients that qualify for and are entitled to care under the new healthcare law.
According to Toby Douglas, California’s Health Care Services Department director, just 10% of the available inpatient beds in the state are in facilities that meet the federal government’s size restrictions [for Medicaid patients].
Most professionals and academics agree the current regulations are not working.
“The unintended consequence is that you are discriminating against an adult who needs help,” said Elizabeth Stanley-Salazar, a vice president at the Phoenix House, which offers drug treatment in a dozen states, including California, Florida and Virginia. “We don’t do that for any other illness or disease.”
Insurance companies continue to fight with physicians and facilities about length of stay and the type of patient treatment that is covered. Currently there are no plans to change any laws, claims Suzanne Fields, a SAMHSA senior adviser on health care financing. Substance abuse and mental health are supposed to be treated equally to other medical issues, yet the Parity Act still has many hurdles to full implementation.