Commentary: The Affordable Care Act’s Role in Addiction Treatment for Grown Children

More young people between 18 and 34 years of age are now living with their parents. The dearth of jobs, high cost of living, and postponement of marriage and children are several factors contributing to the trend. For some families, the arrangement is mutually beneficial and financially advantageous. For others, the arrangement can put a strain on parents’ finances.

Another major trend affecting families today are mental illness and substance use disorders. While behavioral health care has been shown to be effective, only a small fraction of those suffering receive professional treatment. Changes in health care insurance with the passage of the Affordable Care Act (ACA) has left many parents wondering how to get their grown children covered and into treatment.

Many Americans qualify for health coverage under the ACA and don’t know it. No one can be denied care because of pre-existing mental illness or substance use disorders. This means that the majority of those who need addiction treatment should be able to receive it under the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, and both the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, which together comprise the ACA.

Basically, the MHPAEA requires insurance companies to cover mental illness and addiction treatment just as they cover physical disease. To increase access to behavioral health care and addiction treatment, the MHPAEA and ACA combined and, as a result, beginning on July 1, 2014, approximately 87 percent of Americans became eligible for free or affordable rehabilitation for mental and behavioral disorders in addition to substance use disorders, including smoking. Furthermore, parents can keep their children on their policy up to age 26.

Amid overwhelming alcohol and drug use statistics, rates of depression, anxiety and other mental illnesses continue to grow. Suicide rates have risen to new heights as a leading cause of death in Americans under the age of 50.

Relatively few of those who need help actually receive it, and there was an average delay of eight to 10 years between onset of symptoms and intervention before the ACA.

With 16.4 million newly insured out of 319 million Americans, we should expect to see more people seeking help as a result of the ACA. Yet several other barriers to care remain. These include pervasive social stigma and insurance-related issues such as:

• Many remain unaware of their eligibility.
• Physically healthy young Americans elect not to pay premiums, so they lack mental health insurance that they need.
• Millions of Americans and undocumented immigrants are still without coverage.
• There is a lack of mental health services and substance abuse counselors in relationship to need, particularly in rural areas.
• Insurance companies make payments and reimbursements a challenge despite laws.

In addition, various policymakers and presidential candidates have postulated that the ACA should be repealed. It is estimated that such a repeal would result in 24 million uninsured by the year 2025, many young adults and those with pre-existing conditions.

These barriers to care can be overcome, but much is left to the policymakers. In the meantime, families can become proactive by holding insurance companies accountable for covered reimbursement. Refusals to pay, endless forms, difficulty reaching a representative and other obstructionist behavior can be exasperating to families already under tremendous stress. Here are a few tips to cope with uncooperative insurance companies:

• Distribute tasks among family members and supportive others.
• Don’t get upset when a bill arrives because providers generally bill faster than insurance companies pay. Keep your provider updated throughout the process.
• Appeal unfavorable decisions immediately; denials can be appealed in an expedited manner under the ACA.
• Keep all documentation and paperwork.
• Be persistent.
• Seek assistance from state, local and community agencies, organizations and mutual support groups.
• Stay calm and practice good health habits.

Recent legislation now makes treatment available to most Americans suffering from substance use disorders. As more people become aware that affordable coverage and treatment are available to Americans in all socioeconomic brackets, we should begin to see a reduction in the current mental health crisis. Though barriers to care still remain, the ACA has allowed many families to obtain coverage and gain access to addiction treatment for their loved ones.

To learn more about the ACA, visit its official website. For more information about getting treatment for your child with a drug or alcohol problem, read the Treatment eBook.

Dana Connolly, PhD, is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her PhD in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at news@sovhealth.com.