With health care reform and huge anticipated expansions in both public and private insurance coverage, there has been considerable discussion about what will happen to existing funding streams, including the Substance Abuse Prevention and Treatment (SAPT) Block Grant, once the Affordable Care Act coverage provisions are fully implemented.

Health care reform presents a great opportunity to better help people with substance use disorder (SUD) prevention, treatment and recovery support needs to get what they need to become and stay well. Once the law is fully implemented, it is likely that current programs and funding streams will need to adapt to meet new needs.

However, the Affordable Care Act does not define which services constitute each of the essential benefits, including which services must be included in the SUD benefit for plans in the health insurance exchange and the SUD benefit for Medicaid benchmark plans for the expansion population. Until the benefits package better defined for each state, gaps in coverage for SUD services cannot yet be identified and changes to existing funding streams should not be made.

Full implementation of the law is not expected until 2019. In addition, following the U.S. Supreme Court ruling which made the Medicaid expansion optional to states, 24 states are not planning to expand their Medicaid population at this time. Funding for the SAPT Block Grant and other safety net programs must continue to be strong to support those individuals who remain uninsured, through full implementation of the law, and beyond.

Continued federal support, including strong SAPT Block Grant funding, is particularly important in light of the current economic downturn. As unemployment rates and other pressures increase, people at risk for substance use disorders will have even greater needs for life-saving prevention, treatment and recovery support services. According to a recent Center on Budget and Policy Priorities report, at least 46 states have proposed or enacted reduced services to their residents, including some of their most vulnerable populations. Of these states, at least 31 have proposed or implemented cuts to public health programs that will reduce access to critical healthcare services for low-income populations. Community-based organizations that provide essential drug and alcohol prevention, treatment and recovery services are expected to face additional burdens, making it increasingly difficult to meet the needs of the people they serve.

Even with full implementation of the law in 2019, it is estimated that five percent of Americans will remain uninsured. It is also likely that certain SU services, interventions, and strategies will not be included in the basic benefit for those who are covered. Safety net programs including the SAPT Block Grant will need to continue for those services and people not covered by health care reform. In addition, states that have gone toward universal coverage have found that the individuals who remained uncovered are disproportionately people with SUD needs. These individuals will continue to need a strong safety net, including the SAPT Block Grant.

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