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Uncertainty over Medicaid not diminishing magnitude of Court vote

June 28, 2012
by Gary A. Enos, Editor
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Much work ahead for treatment community to aid implementation
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The U.S. Supreme Court’s ruling on the Medicaid expansion component of the Patient Protection and Affordable Care Act might be the one counterpoint to addiction treatment advocates’ glee over the Court’s decision, but few want the uncertainty over Medicaid to overshadow the overall significance of this week’s news.

“It was affirmed today that we are part of mainstream healthcare,” says Carol McDaid, principal with Capitol Decisions and a prominent national lobbyist for addiction treatment and recovery issues. McDaid adds, “We can’t lose sight that addiction and mental health are in the essential benefits package in this law, and that this will begin to destigmatize those treatments in a way that they’ve never been before.”

In the hours following the Court’s 5-4 vote upholding the act’s individual mandate under the federal government’s taxing authority, reverberations were being felt across the U.S. and beyond. Behavioral health consultant and former treatment center and foundation administrator Victor Capoccia, currently traveling in Vietnam as part of a United Nations project on community-based treatment, delivered comments that praised the affirmation of parity benefits while also calling the field into action.

“Our challenge now is to offer addiction and mental health as core health services, linked appropriately with primary care, and following the best standards that are supported by science,” says Capoccia, who will offer a keynote presentation addressing reform models this fall at the National Conference on Addiction Disorders in Orlando, Fla. “Meeting that challenge requires the renewal of our clinical practices, organizational relationships, and orientation to patients.”

A statement from the Legal Action Center applauded the Court’s ruling “with the sole exception that states that decline to comply with the Medicaid expansion will not risk the loss of their existing Medicaid funding.” McDaid says that given that 17 out of the 30 million individuals expected to receive new coverage under the Affordable Care Act would be entering via a Medicaid expansion, the protection of states’ core Medicaid funding if they don’t comply with the ACA’s expansion provisions places this expanded coverage in some doubt.

“It’s unclear whether some states will be motivated to take the federal matching dollars,” says McDaid. The stakes are high for behavioral health advocates, as upwards of half of the Medicaid expansion population is believed to have a substance use or mental health issue, she says.

While some pronouncements before Thursday’s decision hinted that some states opposing the ACA might continue to delay action on implementation if they saw an outcome unfavorable to them, some of those indications seemed to be diminishing after the news broke. McDaid pointed out that Florida officials were stating publicly on Thursday that they would proceed with implementation activity.

McDaid says advocacy efforts in the addiction and mental health fields now will need to encompass numerous activities at the state and federal levels. These must include, she says, involvement as states define terms of benchmark plans in health reform; activity around the terms of federal-state partnerships for the establishment of health insurance exchanges; and continued attention to the need for implementing regulations for the separate federal parity law for behavioral health, without which it will not be possible to define the medical management standards that will be critical to implementing parity benefits for substance abuse and mental health in plans established under the ACA.

Still, notwithstanding the hard work ahead, “The significance of what happened this week, especially for people with addictions and mental illness, there is nothing that could undercut that,” says McDaid.