MEDICAID’S CONSUMER PARADOX: THE CASE OF SUBSTANCE USE DISORDER

The ACA Medicaid-related reforms have significantly improved substance use disorder (SUD) treatment coverage and accessibility. However, for these improvements to be fully realized, expanded coverage must be implemented along with a clear information strategy that assures that eligible individuals understand (1) that SUD treatment services are covered under state Medicaid programs, (2) what specific SUD treatment services are covered, and (3) the specific benefits and restrictions for those services. We examined the process of locating information about SUD benefits on Medicaid websites for all 50 states and the District of Columbia as well as publicly available sources of information on SUD coverage from all 281 Medicaid managed care organizations. Our analysis revealed limited information on behavioral health coverage on both Medicaid and MCO websites, in conjunction with difficult and confusing language and a focus on providers rather than consumers. This presents a major barrier to accessing coverage information and, consequently, accessing treatment services. As Medicaid currently pays for the majority of SUD treatment services, behavioral health benefits information needs to be more accessible and comprehensible to ensure that current and potential Medicaid enrollees know what SUD treatment services and medications are covered and to what extent.