Medicaid Expansion Can Help Address Kentucky’s Substance Abuse Problem

There are many reasons to commend Governor Beshear’s recent announcement that Kentucky will be expanding Medicaid through the Affordable Care Act (ACA). Among the numerous important benefits of the ACA is that it will help with Kentucky’s substance abuse problem—and the Medicaid expansion will further broaden the reach of that benefit.

It’s no secret that Kentucky has a huge substance abuse problem. In 2009-2010, approximately one in 13 Kentuckians age 12 and over—and one in five of those 18 to 25—were dependent upon or abused illicit drugs or alcohol in the previous year, according to a federal survey.¹ The problems with prescription drug abuse, methamphetamine and more recently heroin impact every community.

Despite the state’s substance abuse problem, funding for treatment in Kentucky has been inadequate. A report produced for the legislature in 2010 noted that “with no increase in state or federal funding over the past 14 years, treatment capacity cannot increase and, in fact, cannot maintain its current level of service without reducing the intensity of care provided.” Most treatment facilities are at full capacity, and there are virtually no treatment slots available for the citizen who voluntarily seeks treatment—rather than being referred by the courts, Probation and Parole, or the Department of Community Based Services.² Until the current state budget opened up 5,800 slots over the next two years, Kentucky was one of only seven states that didn’t offer community-based substance abuse treatment through Medicaid.

The good news is that the ACA requires that both Medicaid and the insurance offered through the ACA’s health care exchanges broadly cover substance abuse treatment. This means that through the ACA those who enroll in an exchange in Kentucky (approximately 332,000) and those who are already enrolled in Medicaid (approximately 800,000) will have access to substance abuse treatment in 2014. But because Governor Beshear decided to expand Medicaid in Kentucky, another approximately 308,000 additional Kentuckians will be able to enroll in Medicaid and will have access to substance abuse treatment. Thousands of Kentuckians struggling with addiction problems will now have the opportunity to access treatment.

Increased access to substance abuse treatment will also help Kentucky’s economy. During much of the past fifteen years, the state’s prison population has been one of the fastest growing in the nation—in large part because of the rise in drug offenses. Increasing access to drug treatment through the ACA and Medicaid expansion will complement the state’s existing efforts to reduce incarceration rates and associated costs—namely through the passage of the “Penal Code and Controlled Substances Act” (HB 463) of 2011. The implementation of HB 463 is intended to reduce incarceration and related costs for drug crimes, and the ACA and Kentucky’s Medicaid expansion should further help the state meet the legislation’s goals by reducing the number of Kentuckians abusing drugs.