The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act

Abstract

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and standalone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered.

Homeless and nonhomeless VA service users likely eligible for Medicaid expansion

“…The finding of higher prevalence of substance use disorders among those who are LEME may be important to consider because the Medicaid expansion is expected to change the delivery of public substance abuse treatment services. Reform provisions from the ACA are likely to expand the variety of treatment providers while shifting services away from residential and stand-alone programs toward outpatient and integrated programs [25]. Thus, some VA service users who seek non-VA substance abuse treatment may experience these changes.…”

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…Most programs have been slow to integrate pharmacotherapy into their menu of services, with fewer than 40% of specialty organizations offering buprenorphine treatment (Abraham et al, 2013). However, the diffusion of buprenorphine among physicians represents an example of the integration of SUD treatment into the mainstream health care system that has been advocated in policy circles in recent years (Buck, 2011).…”

“…Greater rates of Medicaid coverage at the state level may actually provide crucial resources to help residents access needed services. SUDs are prevalent within the Medicaid population (Buck, 2011), and Medicaid is an increasingly signifi cant source of payment for treatment services (Mark et al, 2011).…”

The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources

“…First, adoption was facilitated by Medicaid, with those organizations serving a greater proportion of patients covered by Medicaid at baseline being signifi cantly more likely to adopt pharmacotherapy over time. This fi nding is promising in the context of the Affordable Care Act of 2010 (ACA), in which a substantial expansion of the population with Medicaid coverage is expected (Holahan and Headen, 2010), including many with SUDs (Buck, 2011). If publicly funded treatment programs succeed in attracting more patients with Medicaid, our results suggest that greater patient access to pharmacotherapy may follow.…”

“…The impact of Medicaid's expansion will depend in part on how states choose to defi ne "essential benefi ts" as part of their (Buck, 2011). If SUD pharmacotherapy is included as an essential benefi t, this may provide a fi nancial incentive for more SUD treatment programs to adopt these treatments.…”