The Issue

Private health insurance coverage of substance use disorder services and medications has historically been very weak.  Under the federal health care reform law, most small group and individual market insurance plans will be required to cover substance use disorder (SUD) and mental health (MH) services at parity with other covered medical and surgical benefits.  Continued advocacy is needed to ensure that the full range of SUD and MH services and medications are covered in private health insurance plans around the country.

Current Initiatives

National
  • 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
  • Working to improve consumer information provided on New York’s state health coverage exchange.

Policy Recommendations

  • Comprehensive SUD and MH coverage: Private health insurance plans governed by the Affordable Care Act should cover all of the substance use disorder (SUD) and mental health (MH) services and medications a person needs.
  • Vigilant parity enforcement: The federal Department of Health and Human Services (HHS) and states should work closely together to ensure that coverage meets the parity and anti-discrimination requirements of the law, including collecting the data required to ensure compliance and quality.
  • Adequate provider networks: Health insurance plan provider network adequacy standards that ensure timely access to SUD/MH benefits should be developed and enforced.
  • Consumer-oriented exchanges: Health insurance marketplaces should ensure that enrollees can easily identify and choose the health coverage that is best for them.

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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