As a result of the Affordable Care Act (ACA), 30 million people have gained health insurance, which includes coverage for substance use disorder (SUD) treatment. However, SUD programs might be missing out on the growing opportunity to treat those potential patients because they are ill-equipped to serve them, and their state agencies aren’t doing much to help out.
“This massive influx of potential insurance dollars for treatment will become an increasingly important source of financing,” says Christina Andrews, assistant professor of social work at the University of South Carolina, and an author of an article in Health Affairs in May that presented the findings.
Focus on the insured
Andrews sees providers’ focus rightfully shifting toward the population of the insured as a growth segment, with the ability to work with insurers becoming a key differentiator. As a whole, addiction treatment programs still lean toward self-pay and have a long way to go before they can effectively contract with and bill insurance carriers.
According to data cited in the study, more than half of addiction treatment programs do not accept insurance and generally aren’t able to meet insurers’ credentialing requirements. And only half of state agencies are offering SUD treatment providers assistance in developing the infrastructure changes needed to accept insurance.
Authors believe the specialty “must undergo a process of modernization and structural transformation to remain relevant” as ACA becomes further established in the healthcare landscape. Specifically, programs must adapt to changes in healthcare financing.
“The less-well resourced addiction treatment centers, that may not be able to bill insurers or may not have staff that are reimburseable, will have to find ways to identify considerable resources to make the kinds of investments it’s going to take in technology, staffing and infrastructure,” Andrews says.
But providers shouldn’t wait passively for the state or federal government to help them make the connections to insurers and the insured population, she says. Helping programs obtain in-network status with insurers ranked low on the list of ACA-related initiatives that state agencies are currently supporting, according to the study. Only about one in four agencies is offering such assistance to providers.
One point of the study was to bring attention to the issue among state agencies and to inspire healthcare stakeholders to work together to understand their local markets and what it will take to help addiction treatment providers connect with payer sources, Andrews says.
Also ranking low in the list of supports state agencies might offer SUD treatment providers is help with insurance outreach, with only one in four agencies offering such assistance. The outreach could include in-person assistance or any broader awareness effort to drive people to sign up for health coverage. Some communities have teams of federally supported, trained “navigators” who help individuals complete the sign up process, and additionally, providers might also have tools to encourage sign ups when they discover an individual accessing services has no coverage.
“We know people who are struggling with addiction tend to be a more vulnerable population and may be less likely to navigate through the complexity of getting enrolled for coverage because of issues related to addiction,” Andrews says.
Driving people toward insurance coverage would increase the local insured population and thus increase the pool of potential patients who need SUD services and have the means to pay through healthcare coverage.
“There’s money to be made here for the agencies that are able to take advantage and take folks with insurance,” Andrews says. “And they’ll have the win-win of helping people who need services and also be able to strengthen the resource position for the organization itself. Providers who get good at connecting people with the services they need to get enrolled, that’s a big piece of it.”
The study measured the District of Columbia and 50 state agencies that are charged with overseeing SUD treatment programs and allocating block grant funds. Top categories in which agencies seem to provide SUD programs funding and support for ACA implementation include: collaboration with mental health providers; collaboration with criminal justice; training to increase the number of addiction treatment counselors; and Medicaid certification.