Hope for Homeless Individuals with Addictions Under the ACA

written by naehblog
August 5, 2013

Today''s blog post was written by Mohini Venkatesh, senior director of public policy at the National Council for Behavioral Health, and Alanna Tievsky, policy associate.


For too long, homeless individuals have suffered at the hand of individual and systemic stigma. Often blamed for their circumstances, they are forced into the shadows of our communities. Federal and state policies to support the homeless population have been inadequate and often punitive; leaving a murky path to sustainable housing. This situation is only compounded by chronic illnesses like addictions, resulting in further isolation from societal resources.

The data regarding this population is staggering: according to the Substance Abuse and Mental Health Service Administration, 64 percent of homeless individuals have an addiction disorder. Addictions have a tangled relationship with homelessness, and are sometimes a precursor for homelessness and at other times a coping mechanism.

Recent federal policy changes provide better coverage for homeless individuals with addictions. The Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 states that if a health plan covers physical health and mental health/addictions, it must cover all equally.

The Patient Protection & Affordable Care Act establishes a large-scale public and private insurance coverage expansion. For states that have opted to participate in the Medicaid expansion beginning in 2014, all childless adults under 133 percent of Federal Poverty Level — including individuals with addictions as primary diagnosis — will be eligible for federally-funded Medicaid. This provides a special opportunity for states to transition historically state-supported health care services for many uninsured individuals to the federal rolls. Coverage expansion is supported by massive targeted outreach and enrollment efforts, including special support for vulnerable populations and regulations that require a single, streamlined enrollment process. As for the 17 states that are leaning against expanding Medicaid in 2014, they are free to expand in the future.

While coverage expansion is key, it is also necessary to understand what services will be covered under these plans. The ACA identifies the Essential Health Benefits Package, which sets 10 different categories of benefits, including addictions services, that must be included in any health plan that is offered through the Medicaid or private insurance expansion (“health insurance exchange” or “marketplace”).

The ACA also accelerates numerous payment and delivery reforms that affect access to health care. The Medicaid Health Home State Plan Option provides care coordination and holistic services for individuals with multiple chronic conditions (including addictions) and a Medicare demonstration program to support Accountable Care Organizations.

The ACA has its limitations— while funding for many provisions has already been appropriated, future politics could influence long-term funding. Additionally, the ACA provides immense flexibility to states to determine what “health reform” looks like around the country. Coverage expansion and increased access to addictions treatment are only effective if individuals understand their rights and options, and if states are prepared to enroll the 15 million Americans that are newly eligible for Medicaid and the nearly 26 million Americans that qualify to receive subsidies for the marketplace.

What can you do to help our most vulnerable populations? Learn how Medicaid can support your state’s economy and how you can take action. And plan to join mental health and addictions advocates on Capitol Hill, Sept 18-21, to advocate for better resources and supports for homeless people with addictions.


Photo courtesy of Jon Lopez's Flickr photostream.