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Unequal Benefits: Substance Abuse, Mental Health Coverage for Poor in NJ

Wednesday, September 18, 2013

NJ Spotlight

Some low-income New Jersey residents will be eligible for treatment for drug and alcohol addictions, as well as some mental health services, under the upcoming Medicaid expansion. But most Medicaid recipients won’t be eligible for the new benefits.

Under the 2010 Affordable Care Act, states that choose to expand Medicaid – known as New Jersey FamilyCare in the state -- must cover these treatments for people who are newly eligible for the program. However, that provision doesn’t apply to those who are already eligible for the program.

Gov. Chris Christie opted to expand Medicaid eligibility to include residents with incomes above the maximum allowed for the state’s General Assistance program, or $2,520 per year for a single person who isn’t disabled, but below 138 percent of the federal poverty line, which is currently $15,415 for a single person.

This is expected to provide insurance for 104,000 newly covered adults, according to Rutgers Center for State Health Policy estimates. In addition, outreach efforts tied to the Medicaid expansion and the new federal health insurance marketplace or exchange, are expected to draw another 130,000 residents who are already eligible into the program but haven’t enrolled.

The combined 234,000 new recipients will join more than 1 million residents already enrolled in the program.

But only 104,000 newly eligible recipients will be able to receive what state officials described as “alternative benefits.” These include treatments for psychiatric emergencies; non-medical detoxification; and substance use disorder outpatient, halfway house and short-term residential services.

Enrollment for Medicaid expansion will begin on October 1 with coverage starting on January 1, 2014, the same date that other state residents will begin receiving insurance through the federal Affordable Care Act marketplace.

It’s disappointing that not all Medicaid recipients will receive the new coverage, said Dennis Lafer, a consultant for the Mental Health Association in New Jersey.

“We think it’s good that the expanded population are getting these additional services, but we certainly would encourage the state as soon as it’s economically feasible to expand these benefits to the entire population,” said Lafer, former deputy director for the state Division of Mental Health Services.

Lafer said it is “wonderful” that the state opted for Medicaid expansion.

“Many states are going in a different direction,” he said.

The federal government will 100 percent of the cost of covering the newly eligible Medicaid recipients for the next three years, with the state portion of those costs rising to 10 percent by 2020. In comparison, the federal government pays 50 percent of the cost of most Medicaid services for the residents who are now eligible for the program.

Raymond J. Castro, senior policy analyst for the nonprofit New Jersey Policy Perspective, said he understood why the state wouldn’t be able to offer the expanded benefits immediately.

“Ideally we’d like to have everybody have the same higher benefits, but there’s a fiscal issue here,” Castro said. “The view of the state right now is, ‘Let’s see how this works.’ ”

Castro said he believes state officials will be actively reviewing whether the additional coverage is affordable for beneficiaries.

“I think it’s important that the state monitor that,” Castro said. “I think they’re taking this sort of incrementally.”

Lafer noted another major way that people who need mental-health or substance-abuse treatment could benefit from the Affordable Care Act: Insurance plans available through the health insurance marketplace will be required to cover those services.

The marketplace is a website where people will be able to buy insurance and learn whether they are eligible for subsidies.

The mental-health and substance-abuse services are one of 10 essential health benefits required for all qualifying health plans.

The federal government hasn’t released details about the coverage or cost of the plans, although that information is expected to be publicly available by October 1. Therefore, it’s not clear how the required benefits will compare with current available insurance plans.

Lafer said advocates and providers are hopeful that the plans will help residents, but that will depend on how extensive they are and how much they cost. He added, “It can only be helpful as long as the plans cost people a reasonable amount of money.”

This story is available through a WNYC partnership with NJSpotlight.com.

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