The Issue

The Affordable Care Act expands Medicaid eligibility, including to childless adults and some higher income parents for the first time in many states.  The Medicaid expansion population will be guaranteed a package of benefits that includes substance use disorder (SUD) and mental health (MH) benefits at parity with medical and surgical benefits.  Continued work is needed to ensure that the expansion of Medicaid coverage and coverage of SUD and MH services is made real.

Current Initiatives

  • Working to reform Medicaid’s IMD exclusion and improve access to residential addiction treatment.
  • Co-chairing and coordinating the Coalition for Whole Health to ensure the Affordable Care Act is well implemented for people with mental health and substance use disorder service needs.
New York City and State
  • Ensuring New York State’s transition to Medicaid managed care does not result in a loss of substance use coverage or disruptions in treatment.

Policy Recommendations

  • Consumer-focused benefits and enrollment: The federal government and states should design Medicaid benefits and eligibility systems to ensure that eligible individuals with SUD/MH can enroll and access needed services and medications.
  • Comprehensive coverage for newly eligibles: HHS and states should ensure that all newly-eligible and traditional Medicaid beneficiaries receive comprehensive health coverage, including coverage for SUD and MH services and medications, at parity with other covered benefits.
  • Clear and strong parity regulations: Federal regulators should promptly issue additional guidance on the application of the federal parity law to Medicaid managed care, Medicaid Alternative Benefit Plans, and CHIP.  Federal and state regulators should continue working to ensure that parity is fully implemented and enforced in these programs.
  • Expanded use of Health Homes: All states should implement the Medicaid Health Home option and design it to ensure that the SUD/MH needs of all enrollees are addressed.
  • No bed limits for residential substance use treatment facilities: The federal government should modify the IMD exclusion to ensure that everyone with SUD/MH can obtain appropriate care.

Learn More

To learn more about this issue, visit our Substance Use Resources.

To learn more about LAC’s impact, see our Accomplishments.

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