Update: Details on Healthcare Law’s Landmark Expansion of Addiction/Mental Illness Coverage

On March 24, 2010, President Obama signed into law H.R. 3590, the “Patient Protection and Affordable Care Act.” The new law, approved by the U.S. Senate on December 24, 2009 and the U.S. House of Representatives on March 21, 2010, is expected to expand healthcare coverage to tens of millions of Americans that are currently uninsured, resulting in 95 percent of the legal population being covered.

The new federal healthcare law includes a number of provisions aimed at improving coverage for and access to substance use disorder and mental illness prevention, treatment, and recovery services, a result of strong bi-partisan support in Congress and by the Obama Administration in addition to a unified and coordinated effort by advocates for people in need of substance use disorder and mental illness prevention, treatment and recovery support services.

The following is an overview of key components of the final legislation, including critically important addiction and mental health provisions included in the new law. The below also highlights provisions in the reconciliation bill, which was signed into law on March 31st and that amends certain provisions of the new law unrelated to the addiction- and mental health-specific provisions listed below.

Major substance use disorder and mental health provisions in the new law include:

Substance use disorder and mental health (SUD/MH) services in the basic benefit package.
The final bill requires a basic benefit package for all health plans in the individual market and small group markets. All such plans will be required to cover mental health and substance use disorder services.

The requirement that all plans in the health insurance exchange adhere to the provisions of the Wellstone/Domenici Parity Act.
The final bill requires all group and individual plans to comply with Wellstone/Domenici, which requires that SUD/MH benefits be provided in the same way as all other covered medical and surgical benefits.

The requirement that Medicaid enrollees, including newly eligible childless adults, receive adequate health coverage, including SUD/MH coverage.
The final bill expands Medicaid eligibility to 133 percent of federal poverty and requires that all newly eligible parents and childless adults receive basic benefits, including SUD/MH services that must be provided at parity.

SUD/MH in chronic disease prevention initiatives.
The final bill creates a national prevention council with the ONDCP Director as a member and SUD listed as a national priority for that council’s report to Congress. SAMHSA is required to be consulted on issues related to preventing SUD and mental illness.

SUD/MH workforce in health workforce development initiatives.
The final bill includes the capacity of the MH and “behavioral health” workforce as high-priority topics in the bill’s National Workforce Strategy section.

SUD prevention, treatment, and MH service providers to be eligible for community health team grants aimed at supporting medical homes.
The final bill lists SUD and MH service providers among entities eligible for community health team grants.

Additional key provisions of the new law will:

Expand Medicaid coverage to all Americans below 133 percent of the federal poverty level.
This will expand coverage to an additional 16 million Medicaid beneficiaries, including childless adults for the first time in many states.

Create health exchanges for individuals and small employers to pool risk and purchase insurance.
The exchanges seek to improve individual and small group insurance coverage by requiring transparency, mandated benefits and other types of consumer protections.

Provide sliding scale subsidies for individuals and families up to 400 percent of the federal poverty level to purchase or take up offers of health coverage.

Prohibit insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on gender or health status, and placing annual or lifetime caps on insurance coverage.

Require individuals to carry health insurance or pay a financial penalty.
The individual mandate seeks to ensure that risk is pooled among both healthy and non-healthy individuals, lowering costs and reducing the opportunity for people to wait until they are sick to access care.

Close the Medicare “donut hole”.
This provision in the reconciliation bill seeks to lower out of pocket prescription drug costs for Medicare beneficiaries.

Allow adult children to remain on their parents’ insurance until their 27th birthday.

Create a national high risk pool for adults with preexisting conditions.
Adults with pre-existing medical conditions will be able to buy into a national high risk pool until the health exchanges are implemented.

Reduce the federal deficit by $138 billion over the next 10 years and $1.3 trillion over the following 10 years.
According to Congressional Budget Office estimates, the new law and Congress-approved reconciliation package pending in the Senate will result in significant reductions to the federal deficit.

Legal Action Center is continuing to analyze the new federal law and will release more analysis in the coming days and weeks. The full impact of many provisions will remain unclear until details are worked out through the regulatory process.


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