Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis
Introduction: : People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-06-01
|
| Series: | Drug and Alcohol Dependence Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772724622000294 |
| _version_ | 1811290625412169728 |
|---|---|
| author | Julia Dickson-Gomez Margaret Weeks Danielle Green Sophie Boutouis Carol Galletly Erika Christenson |
| author_facet | Julia Dickson-Gomez Margaret Weeks Danielle Green Sophie Boutouis Carol Galletly Erika Christenson |
| author_sort | Julia Dickson-Gomez |
| collection | DOAJ |
| description | Introduction: : People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use disorder. Few studies to date have conducted qualitative research with substance use disorder (SUD) treatment providers regarding Medicaid and other insurance coverage of SUD treatment following passage of the ACA and parity laws. The present paper fills this gap by reporting data from in-depth interviews with treatment providers from three states, Connecticut, Kentucky, and Wisconsin, that differ in implementation of the ACA. Methods: : Study teams in each state conducted in-depth, semi-structured interviews with key informants who provided SUD treatment, including providers of behavioral health residential or outpatient programs, office-based buprenorphine providers and opioid treatment programs [OTP, i.e. methadone clinics] (n = 24 in Connecticut, n = 63 in Kentucky and n = 63 in Wisconsin). Key informants were asked for their perceptions on how Medicaid and private insurance facilitates or limits access to drug treatment. All interviews were transcribed verbatim and analyzed for key themes using MAXQDA software using a collaborative approach. Results: : Results from this study suggest that the promise of the ACA and parity laws to increase access to SUD treatment has only partially been realized. There is wide variation among the three states’ Medicaid programs and among private insurance in the types of SUD treatment that is covered. Neither Kentucky's nor Connecticut's Medicaid covered methadone. Wisconsin Medicaid did not cover residential or intensive outpatient treatment. Thus, none of the states studied here provided all levels of care that the ASAM recommends for treating SUD. Further, there were several quantitative limits placed on SUD treatment such as number of urine drug screens or visits allowed. Providers complained that many treatments required prior authorizations, including MOUD like buprenorphine Conclusions: : More reform is needed to make SUD treatment accessible to all who need it. Such reforms should consider defining standards for opioid use disorder treatment with reference to evidence-based practices, not be attempting parity with an arbitrarily defined medical standard. |
| first_indexed | 2024-04-13T04:15:59Z |
| format | Article |
| id | doaj.art-f174867c4f144da4bd21440003081ebf |
| institution | Directory Open Access Journal |
| issn | 2772-7246 |
| language | English |
| last_indexed | 2024-04-13T04:15:59Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Drug and Alcohol Dependence Reports |
| spelling | doaj.art-f174867c4f144da4bd21440003081ebf2022-12-22T03:02:58ZengElsevierDrug and Alcohol Dependence Reports2772-72462022-06-013100051Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysisJulia Dickson-Gomez0Margaret Weeks1Danielle Green2Sophie Boutouis3Carol Galletly4Erika Christenson5Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States; Corresponding author.Institute for Community Research, Hartford, CT, United StatesInstitute for Community Research, Hartford, CT, United StatesDepartment of Psychology, University of Texas, Dallas, United StatesCenter for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United StatesCenter of Excellence in Women's Health, Boston Medical Center, BUSM, New EnglandIntroduction: : People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use disorder. Few studies to date have conducted qualitative research with substance use disorder (SUD) treatment providers regarding Medicaid and other insurance coverage of SUD treatment following passage of the ACA and parity laws. The present paper fills this gap by reporting data from in-depth interviews with treatment providers from three states, Connecticut, Kentucky, and Wisconsin, that differ in implementation of the ACA. Methods: : Study teams in each state conducted in-depth, semi-structured interviews with key informants who provided SUD treatment, including providers of behavioral health residential or outpatient programs, office-based buprenorphine providers and opioid treatment programs [OTP, i.e. methadone clinics] (n = 24 in Connecticut, n = 63 in Kentucky and n = 63 in Wisconsin). Key informants were asked for their perceptions on how Medicaid and private insurance facilitates or limits access to drug treatment. All interviews were transcribed verbatim and analyzed for key themes using MAXQDA software using a collaborative approach. Results: : Results from this study suggest that the promise of the ACA and parity laws to increase access to SUD treatment has only partially been realized. There is wide variation among the three states’ Medicaid programs and among private insurance in the types of SUD treatment that is covered. Neither Kentucky's nor Connecticut's Medicaid covered methadone. Wisconsin Medicaid did not cover residential or intensive outpatient treatment. Thus, none of the states studied here provided all levels of care that the ASAM recommends for treating SUD. Further, there were several quantitative limits placed on SUD treatment such as number of urine drug screens or visits allowed. Providers complained that many treatments required prior authorizations, including MOUD like buprenorphine Conclusions: : More reform is needed to make SUD treatment accessible to all who need it. Such reforms should consider defining standards for opioid use disorder treatment with reference to evidence-based practices, not be attempting parity with an arbitrarily defined medical standard.http://www.sciencedirect.com/science/article/pii/S2772724622000294Parity lawsSubstance use disorderMedications to treat opioid use disorderMethadoneBuprenorphineMedicaid |
| spellingShingle | Julia Dickson-Gomez Margaret Weeks Danielle Green Sophie Boutouis Carol Galletly Erika Christenson Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis Drug and Alcohol Dependence Reports Parity laws Substance use disorder Medications to treat opioid use disorder Methadone Buprenorphine Medicaid |
| title | Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis |
| title_full | Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis |
| title_fullStr | Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis |
| title_full_unstemmed | Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis |
| title_short | Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis |
| title_sort | insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act a qualitative analysis |
| topic | Parity laws Substance use disorder Medications to treat opioid use disorder Methadone Buprenorphine Medicaid |
| url | http://www.sciencedirect.com/science/article/pii/S2772724622000294 |
| work_keys_str_mv | AT juliadicksongomez insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis AT margaretweeks insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis AT daniellegreen insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis AT sophieboutouis insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis AT carolgalletly insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis AT erikachristenson insurancebarrierstosubstanceusedisordertreatmentafterpassageofmentalhealthandaddictionparitylawsandtheaffordablecareactaqualitativeanalysis |