Insurance Coverage for Addiction Treatment Lacking Across the Country, Says New CASA Report

Insurance Coverage for Addiction Treatment Lacking Across the Country, Says New CASA Report

Insurance plans across the country don't cover the necessary treatments for people with addiction, says a new report from the National Center on Addiction and Substance Abuse (CASA). The nationwide review of insurance coverage, titled "Uncovering Coverage Gaps: A Review of Addiction Benefits in ACA Plans," reveals that insurance plans across the U.S. are not covering the necessary treatments for people with addiction as called for under the Affordable Care Act (ACA) or Obamacare, as the ACA has come to be known in the media. Historically, insurance coverage for addiction treatment has been inadequate, CASA says, but the ACA "holds great promise for expanding access to addiction treatment." The Act attempted to address these shortcomings by mandating that "substance use disorder services" be covered at parity - that is, equal or comparable to medical and surgical benefits. Unfortunately, the ACA fails to spell out just what addiction benefits should be covered. This has left it up to each state to work out what it wants to cover - and what it doesn't want to cover. The results have been less than encouraging for those in the field of substance use and abuse, and the thousands of patients seeking treatment on a daily basis. In fact, CASA says its findings were "disheartening." Its comprehensive review of addiction benefits offered across the country revealed "major gaps in coverage." "Addiction benefits offered in the 2017 Essential Health Benefits (EHB) benchmark plans found that none of the plans provide adequate addiction benefits, and over two-thirds violate the Affordable Care Act," CASA said.

Harmful treatment limitations

None of the plans in all 50 states provided comprehensive coverage for addiction, CASA said. This means none cover the "full array of critical benefits without harmful treatment limitations." CASA reviewed each state's 2017 EHB-benchmark plan to determine whether the plan:

  1. Satisfies the ACA's requirements regarding coverage of addiction benefits
  2. Complies with parity requirements
  3. Provides adequate care for addiction by covering the full range of critical benefits without imposing harmful treatment limitations
  4. Provides enough information to fully evaluate compliance and adequacy of benefits.
The key findings to each of these four points revealed:
  1. Over two-thirds of the plans contained obvious violations of the ACA's requirements for coverage of addiction benefits
  2. 18 percent of the plans lacked compliance with parity requirements; 31 percent of the plans contained possible parity violations
  3. None of the plans provided comprehensive coverage for addiction by covering the full array of critical benefits without harmful treatment limitations; the most frequently excluded or not explicitly covered benefits were residential treatment and methadone maintenance therapy
  4. Plan documents for 88 percent of state plans lacked sufficient detail to fully evaluate parity compliance and/or the adequacy of addiction benefits.

Parity or not, state by state

The CASA report contains a map of the 50 states, keyed to their degree of compliance to the ACA in providing parity. Each state was assigned to one of 5 categories, from no violations to multiple violations.

  • No Parity Violations included Minnesota, Wisconsin, Pennsylvania, Maine, Missouri, Oklahoma, Kentucky, Georgia and N. Carolina.
  • One Parity Violation was found in each of Montana, Texas, Michigan and Rhode Island. Multiple Parity Violations were revealed in Alaska, S. Dakota, Mississippi, Alabama and S. Carolina.
  • Possible Parity Violations were found in 16 states.
  • Parity Compliance Couldn't Be Determined in 16 other states.
We all know that insurance, particularly medical insurance, is far from simple. In fact, understanding and working with all the complexities of the ACA, Medicare, Medicaid and all the private plans in the country is definitely up there with rocket science and atomic fission. In spite of the complexities, the CASA report calls on the states and insurers to revise their plans to comply with the law, and cover the full range of effective addiction treatments. Only then, CASA says, will people with addiction receive benefits comparable to medical and surgical benefits as mandated by the ACA. "When people cannot access effective treatment, it can lead to disability or premature death, and a range of other costly health and social consequences," CASA said. "Conversely, effective treatment has been shown to not only save lives, but also to reduce health care costs and decrease drug-related crimes. "In order to fulfill the ACA's intent of dramatically expanding access to addiction treatment," CASA says, "states should revise their EHB benchmark plans to comply with the law and ensure comprehensive coverage of evidence-based addiction benefits without harmful treatment limitations. This will help to close the addiction treatment gap, improve the health of patients seeking addiction treatment, and decrease costs for the health plans in the long-term."

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