Wonky Word: Substance Use Disorders (SUDs)

The debate continues around the House-passed American Health Care Act (AHCA) and now the Senate’s effort to craft a similar bill that will effectively end Medicaid expansion, dramatically cut Medicaid funding, and result in loss of coverage for millions of Americans. In our effort to continue to provide information on AHCA, we provided details earlier this week on what Essential Health Benefits (EHBs) are. One of these ten EHBs is mental health and substance use disorder (SUD) services, which includes behavioral health treatment. Substance use disorder, also known as drug use disorder, is a condition in which the use of one or more psychoactive substances leads to a clinically significant impairment or distress.

Substance use disorders are a nationwide problem, and Montana is all too familiar with alcohol and drug abuse. Montana residents have a higher rate of alcohol dependence or abuse than the national average, as well as a higher rate of untreated illicit drug dependence or abuse.

At the end of May, the Montana Department of Justice announced a new effort through the office’s Aid Montana initiative to gather input from Montanans regarding how best to address substance abuse. Over the summer, the Montana Department of Justice will partner with the Montana Healthcare Foundation to hold six listening sessions across the state to hear real life experiences of individuals affected by substance abuse.

These listening sessions should provide great feedback; however, there is one thing we already know: the Affordable Care Act and Medicaid Expansion funding provide the foundation to effectively addressing substance use disorders. The ACA and the state’s Medicaid expansion provide critical resources and services to those Montana residents battling addiction personally and the family members impacted by drug and alcohol abuse.

While we do not know what will be included in the Senate’s version, press reports indicate the Senate is sticking fairly close the House-passed bill, which would land a devastating blow to mental health and opioid addiction treatment due to the following components of the bill:

  • Dramatic cuts to Medicaid will cut billions in federal funds provided for substance use disorder treatment. Since 2015, Medicaid has become our state’s primary payer for SUD treatment services and Montana’s most potent
tool in combatting alcoholism, methamphetamine use, opioid abuse and overdose, and the myriad social consequences of addiction. In fact, since the passage of Medicaid expansion, Montana has seen a 67% increase in federal dollars going toward SUD treatment. A radical restructure of Medicaid, by converting it to a per capita cap will result in the loss of nearly $5 billion in federal Medicaid funds.  To compensate, Montana would have little choice but to cut eligibility, cut payments to hospitals and doctors, and/or cut benefits — including behavioral health services.
  • A return to pre-ACA coverage could result in the elimination of mental health and substance use treatment in private insurance plans. The AHCA allows states to waive certain essential health benefits, and this includes mental health and substance use treatment. Prior to ACA, almost no state required insurance companies to cover these services, and it is likely states will again start waiving these benefits.

As in most states, substance use disorder is a serious and growing public health problem in Montana. We can face this problem head on by maintaining the crucial federal Medicaid funds to pay for substance use disorder treatment. We can’t afford to lose this lifeline to recovery in Montana.

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