By Alison Knopf
In one respect, opioid treatment programs (OTPs) have an advantage over most areas of health care, when it comes to uncertainty about insurance in the future. If even the worst scenario came to pass (zero coverage for treatment, and that is unlikely), it wouldn’t be an unusual situation for OTPs. Unfortunately, OTP patients are used to paying out of pocket in many cases.
“It’s always been true, no matter what administration we’re under, that the most certain method of achieving sustained financial stability is a direct out-of-pocket payment, from patient to program,” said Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), in an interview with AT Forum. At the time of the interview, Congress was considering a tax bill that would have massive effects on health insurance, Medicaid, and Medicare.
The Fewer Payers, The Better
To the extent that they already have such patient-pay models, OTPs are insulated from insurance changes. “As a practical reality, the fewer parties you have in any payment scheme, the better,” said Mr. Parrino. “If you get a direct payment, there’s no delay. If you bill Medicaid, you’re going to wait weeks. If you bill Medicare, you’re waiting months.” (Some OTP patients are Medicare-eligible because of disability; AATOD is working to get Medicare coverage for patients based on age, as well.)
This is not to say that Mr. Parrino wants to see this happen. He, and AATOD, have worked tirelessly to have Medicaid and Medicare, as well as commercial insurance, reimburse programs and patients for OTP services.
Non-Medicaid States: No Access If You Can’t Pay
The comparison is stunning: 85% of patients in non-Medicaid states make out-of-pocket payments. And 85% of patients in Medicaid states have their treatment paid by Medicaid. “The implication is that those who can’t afford treatment simply don’t access care,” said Mr. Parrino. It’s also important for the Medicaid rate to be high enough to attract providers, he said.
Health care uncertainty has been pretty constant since President Trump, who vowed to repeal the Affordable Care Act, took office. Congress tried for repeal, but failed. Americans are signing up for health care, and, Medicaid expansion, it appears, will continue.
So OTPs with the self-pay model can expand their services to Medicaid—and patients covered by commercial insurance, and OTPs, as a public model, can continue to rely on Medicaid, ACA plans, and the Substance Abuse Prevention and Treatment block grant.