Why Many Addicts Don’t Get Help – Exposing the Treatment Gap

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shutterstock 601874048

The United States currently struggles with twenty-three million of its population being addicted to drugs and alcohol. This is more than ten percent of the U.S. adult population. A health problem of this order of magnitude qualifies as a full on addiction epidemic, yet people are not getting help for it on the order of magnitude that they should. There is a significant treatment gap. Millions are addicted, yet few ever get the help that they need for their drug dependence crisis.

Dated Federal Laws Bypass the Best Efforts for Helping Addicts

Let’s explore this. The Affordable Care Act of 2009 attempted to make addiction treatment available for all who were afflicted, not just those who could easily afford it. The Affordable Care Act promised sweeping changes to help millions of people with substance dependence. According to the bylines of the Affordable Care Act, those who are newly insured through Medicaid are supposedly guaranteed treatment for addiction through government-funded recovery programs.

But things didn’t exactly work out as planned. Congressional bureaucracy, ancient laws, constricting policy, taxation disagreements, and a plethora of other difficult factors impeded the forward progress the nation has made in trying to treat everyone who needs addiction help. Federal laws governing Medicaid-covered programs still exist that restrict the number of beds available for each state, thus bottle-necking care offered to addicts and actually creating the substance abuse epidemic into what it is today.

Restrictions on Medicaid-Covered Treatment Centers

According to the Substance Abuse and Mental Health Services Administration, more than twenty-three million Americans are harmed by a substance abuse crisis. However, only about eleven percent of those who need treatment for addiction ever actually receive it. If the cancer problem or the diabetes problem or the heart problem had statistics on treatment gaps like this, there would be public outcry and outrage. But those areas are well cared for. Unfortunately, the stigma that abounds and surrounds addiction creates a difficult scenario where addicts are frowned upon for suffering from their controlling and seemingly inescapable habits.

Under decades-old federal restrictions that the Affordable Care Act was not able to remove, drug treatment centers with more than sixteen beds couldn’t bill Medicaid for residential services provided to low-income or impoverished adults. Why? This law was actually first put in place to avoid the unethical use of Medicaid. Essentially, the law stands to prevent Medicaid funding from going to private, mental health institutions which would profit from endless Medicaid funding by warehousing mental health patients. This has happened before on countless occasions with entire mental hospitals being closed down for medical malpractice and insurance fraud, so the provisions were well-founded originally.

Unfortunately, these old laws solved one problem but then created another one. The unintended consequences here are that actual drug addicts and alcoholics are being denied care for fear of malpractice or insurance fraud. Once again, we have the phenomena of the immorality and unethical practices of a few people or institutions having a negative effect on the many.

Why Such Restrictions are Dated

California’s Health Care Services Department Director wrote to the Centers for Medicare and Medicaid Services on this subject, showing the Medicaid department that the archaic, federal size restrictions were extremely outdated. He showed the department that only ten percent of California addiction treatment centers met the size restrictions for Medicaid coverage. The problem is, far more than the majority of Californians seeking help for behavioral habits and substance abuse have only Medicaid as their form of payment. Essentially, old rules are creating a treatment gap for people who really do need help.

This problem is mirrored in Colorado. According to medical experts in that state, the vast majority of addiction treatment that occurs in Colorado occurs in treatment centers that have more than sixteen beds, treatment centers that sadly cannot accept Medicaid under current laws. Again, we have a disparity where the majority of addicts have to select from the minority of treatment centers in their efforts to find help, creating a bottleneck for desperately needed addiction treatment.

Pushing for a Resolution

For an addict to actually want to get help for their habit is a miracle in and of itself, so it is important for struggling addicts to have treatment available to them when they desire it. There is nothing sadder than a person suffering from a life-threatening illness and not being able to get help for it because of archaic laws.

The face of addiction in the U.S. has changed much since those federal laws governing Medicaid coverage were first made. Back then, a sixteen-bed treatment center was considered large. Now, it is considered quite small. To meet the growing demand for effective, reliable, and available recovery options, we must change federal policy to allow for Medicaid coverage at thousands-more treatment centers across the nation.





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