Medicare Needs Better Coverage of Substance Use Disorder Services

Medicare Rights partnered with the Legal Action Center and the Center for Medicare Advocacy this week on a STAT First Opinion article to urge greater coverage of substance use disorder (SUD) treatment in Medicare. This comes as a push to remove barriers to mental health and SUD treatment gains traction in Congress.

As we note in the article, Medicare is not subject to the Mental Health Parity and Addiction Equity Act of 1996 (Parity Act). This means that people with Medicare lack access to some treatments and may face lifetime limits for certain mental health-related hospitalizations. These policies are particularly dangerous today when there is an escalating overdose crisis and an estimated 1.7 million people with Medicare are living with diagnosed substance use disorders. Researchers estimate that in 2021, only 11% of Medicare beneficiaries with an SUD received treatment for their condition; unaffordability was cited as a leading barrier to care.

To help call attention to the need to combat these disparities, Medicare Rights joined the Legal Action Center and the Center for Medicare Advocacy in July to establish principles for parity in Medicare coverage. Since that time, members of Congress have introduced and marked up bipartisan bills that would ease access to care for people with Medicare. Among other provisions, the bills would require the collection of additional data on psychiatric hospitals and psychiatric units; establish coverage of intensive outpatient services under Medicare; include Federally Qualified Health Centers and Rural Health Clinics as settings where intensive outpatient services can be furnished; authorize coverage of Marriage and Family Therapists and Mental Health Counselors as Medicare providers; and require the U.S. Department of Health and Human Services to conduct outreach to providers on general behavioral health integration as well as to providers and beneficiaries on billing and eligibility for opioid treatment program services.

These bills would take important steps, and we urge swift passage. We also continue to advocate for full parity in Medicare. It is past time for older adults and people with disabilities to have access to affordable treatment for the full range of services they need.

Read the opinion piece.

Read about our support for bipartisan Congressional action.

Read more about the principles for parity in Medicare coverage.