Obscure federal rule restricting Medicaid addiction treatment options

An obscure federal rule enacted almost 50 years ago could have a significant impact on substance abuse treatment in Ohio and the 25 other states that have expanded Medicaid under the ACA (Source: “Obscure Rule Restricts Health Law’s Expansion of Care for Addicts,” New York Times, July 10, 2014).

Under the rule, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds. The rule was intended to prevent Medicaid funds from covering treatment in state psychiatric hospitals, which were far more common when it was written in 1965. The federal government considered such treatment a state responsibility, and it included residential programs for substance abuse under the exclusion.

While millions of low-income addicts have been promised access to treatment through the Medicaid expansion, the rule will most likely prevent many from entering residential programs, a more intensive form of care, even as heroin addiction is surging in many states.