Substance Abuse and Mental Health Care Mandatory Under Affordable Care Act Measures


Uninsured Marylanders dealing with substance abuse and mental health issues now have more options for coverage as a result of the Protection and Affordable Care Act, or PPACA.

The marketplace exchange began a tumultuous enrollment period on Oct. 1 and, as with coverage for individuals using medical assistance, benefits applied for before the Dec. 24 deadline began on Jan. 1.

Health advocates across Maryland said that the PPACA mandate requiring exchange insurance providers to adequately address substance abuse and mental health treatment not only ensures better care, but provides easier access to more programs.

“The expansion of medical assistance and the introduction of the exchange plans will mean that many, many more Marylanders that aren’t covered right now will be covered by insurance,” said Kathleen Rebbert-Franklin, acting director of the Alcohol and Drug Abuse Administration, located in Catonsville, Md.

Uninsured Marylanders have until March 31 to enroll in some type of insurance plan, whether through the insurance marketplace, Medicaid, an employer, or a family member’s benefits.

Under the PPACA, substance abuse and mental healthcare treatment receives parity with other coverage, meaning that individuals can receive the same type of help to cover the cost of these services as they would with other medical conditions such as asthma, diabetes, and heart disease.

According to the Centers for Medicaid and Medicare Services, benefits include coverage for counseling sessions and psychotherapy. Individuals living in high-risk populations are deemed priorities under the PPACA.

Residential services will be heavily funded through block grants for adults, and outpatient and inpatient services for substance abuse treatment will be more widely available, including the option of co-pays and deductibles for treatments that use drug therapy.

“The costs to society of uncovered individuals are huge,” said Rebbert-Franklin. “People go into hospitals and have uncompensated care—they don’t get themselves treated for an illness and they wait until it gets to the point where they have to go to an emergency room.”

Rebbert-Franklin said that grants to expand substance abuse and mental health services and provide greater access to programs ultimately increase the number of individuals able to receive the help they need.

According to her, states with their own marketplace such as Maryland are required to “establish what the benefits are going to be for those individuals who fall between 138 and 400 percent of the federal poverty level.”

“They are going to get cost offsets when they purchase their health insurance. It will not be free, they will have to pay for their health insurance, but it will be offered at a reduced rate,” she said.

The Department of Health and Human Services uses the poverty level to decide who is qualified for certain benefits and services. For a family of four, 100 to 400 percent of the poverty level is $23,550 to $94,200.

Rebbert-Franklin said better care is available for childless-individuals who currently qualify for Primary Adult Care, or PAC, a smaller version of Medicaid. For a single American, who claims no other individuals on their taxes, 100 to 400 percent of the federal poverty level is $11,490 to $45,960.

On Jan. 1, individuals enrolled in PAC became covered by medical assistance, which offers substance abuse treatments and mental health services.

Though the Healthcare.gov website is now available, several states including Maryland have chosen to operate their own tailored marketplace that meets the federal guidelines within the PPACA.

Maryland’s health insurance exchange is called the Maryland Health Connection. Insurance offered through employers are not held to the same standards as the Maryland Health Connection benefits. Among the differences, the mandate that substance abuse and mental health services must be included in health insurance plans only applies to health plans that are included in the exchange or through Medicaid, Medicare, and medical assistance.

The reductions in cost and health subsidies could prove to be especially helpful in Baltimore, where Commissioner Anthony W. Batts is in an ongoing fight to break the city’s deep-rooted relationship with heroin.

Service providers for substance abuse said it’s been a long time coming, but the city is finally moving toward more widespread, established help for drug dependence and mental health.

“There’s no question that over the history of this program there has been a need to steadily push for expanded availability and access for all kinds of people,” said Bernard J. McBride, president and CEO of the Behavioral Health System of Baltimore.

McBride agreed that a ramp-up in resources for substance abuse is long overdue, but said he was pleased to see the city and the country taking steps to rectify the situation.

“It has been an effort to continually expand people’s knowledge and acceptance of the problems that underline these issues,” he said. “With the Affordable Care Act, there also is the expectation that we will all do a better job of coordinating the various elements of health care.”

As part of the city’s efforts to better serve residents, mental health related services and substance abuse related services have merged to create a new entity called the Baltimore Substance Abuse Systems. McBride was chosen to oversee the new organization.

Many uninsured Baltimoreans have already received grants to address their needs through the Baltimore Substance Abuse Systems, an organization that has also been essential in keeping other current programs up to par with grant money.

“It enables us to think more carefully about both an individual’s mental health and substance abuse problems. It promotes a higher level of integrated services,” said McBride. “There is recognition that the coordinating of behavioral health- which includes mental health and substance abuse treatment- is just as essential as physical health provisions.”

According to Ann Ciekot, an advocacy consultant for the Maryland Chapter of the National Council on Alcoholism and Drug Dependence, the new provisions also mean more efficient care for Baltimoreans dealing with both substance abuse and mental health issues, which can occur at the same time.

“There are certainly people who have substance abuse diagnoses with no mental health diagnoses, and vice versa. However, there is a significant overlap,” said Ciekot.

According to the Substance Abuse and Mental health Services Administration, as many as 8.9 million Americans are dealing with co-occuring disorders, or a diagnosis that includes a substance abuse issue along with a mental health problem.

Less than 8 percent are getting treatment for both issues, and according to the administration, more than half—55 percent—receive no type of treatment at all.

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Substance Abuse and Mental Health Care Mandatory Under Affordable Care Act Measures

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