A Responsible Approach to Healthcare Reform and SUD Treatment

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According to estimates from the 2009-2010 National Survey on Drug Use and Health, every year nearly three million Californians find themselves in need of treatment for substance abuse—but do not receive help. One of the more commonly cited reasons is lack of affordable or insured services. As healthcare reform comes to fruition over the next six months, expansions in insurance benefits should help this underserved population access substance use disorder (SUD) treatment at agencies like CLARE. As a treatment provider, it is our responsibility to ensure that we are prepared to serve this growing population. We are ready to embrace that responsibility, and we look forward to reaching even more individuals who need our effective, cost-efficient treatment through Conscious Recovery, our mid-market outpatient program that will be opening this fall.

But the responsibility for successfully expanding SUD treatment under the healthcare reform mandate does not begin and end with the treatment providers. A major part of the onus falls on California lawmakers, who will be responsible for embracing this monumental opportunity to expand not only the availability of SUD treatment, but also the basic quality of care received by those accessing that treatment.

The success of this endeavor is inexorably tied to the future of MediCal (California’s Medicaid program), which will soon be available to Californians who are at or below 138% of the federal poverty guidelines. In the present MediCal structure, SUD benefits are not part of primary healthcare, but rather are “carved” out into a separate program called Drug MediCal, which offers limited SUD benefits that cover only daycare rehabilitative services, outpatient treatment, medication-assisted therapies, and treatment for perinatal women.

Rather than attempting to improve on this inefficient and antiquated structure, the current budget proposal from Governor Brown preserves the existing, limited Drug MediCal benefits. This structure does not provide the robust continuum of SUD services that many treatment providers and advocacy groups are calling for, nor does it take the necessary step of making the expansion of Drug MediCal a statewide issue.

Rather, the proposed budget offers individual counties an “opt-in” clause that would allow them to choose to provide an enhanced SUD benefit package to Drug MediCal-eligible individuals on a county-by-county basis. This clause makes the Governor’s proposal all the more troubling because it allows California to skirt the issue of defining a statewide benefit for SUD treatment. This definition is necessary not only for compliance with the Affordable Care Act (ACA), but also for ensuring that benefits for SUD treatment live up to federal parity guidelines, which state that, as an essential health benefit, SUD treatment requires the same basic level of coverage as mental and physical health.

By refusing to set a statewide standard for SUD treatment benefits and placing the onus for Drug MediCal expansion on the shoulders of fiscally strapped counties, the current budget proposal threatens to leave an already underserved population with few resources for quality SUD treatment. This budget does not move California toward the stated “triple aim” of the ACA: enhancing the health of populations, improving the experience of care, and controlling healthcare costs. Keeping the current, sub-standard SUD treatment benefits relegated to a secondary position would actually move us away from these aims and put California out of compliance with essential provisions of the ACA.

In order to ensure that healthcare expansion realizes its promise for underserved populations struggling with SUD, it is essential that our state adopt a budget that makes Drug MediCal expansion a statewide issue and promises a substantial basket of benefits for SUD treatment. As the Governor and our state legislators continue discussions about the future of healthcare reform, we urge you to make your voice heard: stay informed by following the updates that we and others provide on emerging legislation and policies, and let your state representatives know that this issue is of particular importance to you.

By working together, we can effect positive change and ensure that everyone who comes to CLARE has insurance coverage that entitles them to a robust continuum of care. CLARE is already preparing for this future, and we look forward to working with our legislators, our fellow treatment providers, and our constituents to help healthcare reform fulfill its promise to the millions of Californians who need effective and compassionate treatment and recovery services.

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