Newly Covered Addicts Unable To Get Residential Care

Under an obscure, 50-year-old rule, Medicaid covers residential addiction treatment only if a center has 16 or fewer beds, severely limiting options for newly covered drug addicts and alcoholics, reports The New York Times. Meanwhile, some Californians whose doctors are not in their plans have been able to switch coverage after the deadline because of the law's "qualifying life events" provision, according to the San Jose Mercury News.

The New York Times: Obscure Rule Restricts Health Law’s Expansion Of Care For Addicts
The law allowed states to expand Medicaid to many more low-income people, meaning that drug addicts and alcoholics who were previously ineligible could now receive coverage for substance abuse treatment, which the law has deemed an “essential health benefit.” But there is a hitch: Under an obscure federal rule enacted almost 50 years ago, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds (Goodnough, 7/10).

Earlier, related KHN coverage: Barriers Remain Despite Health Law's Push To Expand Access To Substance Abuse Treatment (Gorman, 4/10).

The San Jose Mercury News: Obamacare: Little-known Provision Allows Californians Stuck In Bad Plans To Switch
Furious after discovering that their longtime doctors weren't part of their new Anthem Blue Cross plans under the federal health care law, many Bay Area residents didn't just get mad. They got even. They called the Covered California health insurance exchange and switched to plans that accept their physicians. Exchange officials say it's possible to change plans even after the mid-April open-enrollment deadline because of a little-known provision under the "qualifying life events" section for special enrollment (Seipel, 7/10).

Modern Healthcare: Most Insurers Hit Medical-loss Ratio Requirements: GAO
Roughly three-quarters of health insurers spent enough money on medical care to avoid paying refunds to their customers in 2011 and 2012, according to a report issued by the U.S. Government Accountability Office. Insurers operating in the individual, small group and large group markets spent a median of 88% on medical care during those two years.  Under the Patient Protection and Affordable Care Act, insurers are generally required to maintain medical-loss ratios of at least 80% for the individual and small group markets, and 85% for the large group market. Health plans that fail to spend enough money on medical care are required to refund money to their customers. (A small group is typically defined as an employer with fewer than 50 employees) (Demko, 7/10).

Fox News: Court Decision Looms In Subsidy Challenge That Could Unravel Obamacare
A few blocks down the street from where the U.S. Supreme Court recently issued its ruling in the Hobby Lobby case, a powerful federal appeals court is preparing its own decision in a case that could cause serious complications for Obamacare. The case, Halbig v Sebelius, is a major legal challenge that cuts to the heart of the Affordable Care Act by going after the legality of massive federal subsidies and those who benefit from them. A ruling could come as early as Friday (Chakraborty, 7/10).


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