1. Healthcare Reform for Gender Specific Treatment in MA March 7, 2011

2. Healthcare Reform for Women (18-64) in MA Key Improvements MA passed healthcare reform legislation in 2006 In fall 2009, 97.1% of women in MA were insured; up from 91.4% in fall of 2006 Gains in affordability of care more limited, but unmet need because of cost decreased under health care reform, both overall (down 3.7%), and for doctor care; medical tests, treatment, or follow-up care; prescription drugs; and dental care. Gains strong for lower income women, racial/ethnic minority women, and women without dependent children “The Impacts of Health Reform on Health Insurance Coverage and Healthcare Access, Use, and Affordability for Women in Massachusetts,” S. Long and K Stockley, the Urban Institute; L. Birchfield and S. Schulman, Blue Cross Blue Shield of Massachusetts Foundation, June 2010, pg 3

3. Healthcare Reform for Women (18-64) in MA Key Challenges The majority of women that remained uninsured in fall 2009 (approx. 60,000) have incomes below 300 percent of federal poverty level, suggesting need for more targeted outreach More than 1 in 5 women reported difficulty finding a provider who would see them, and 1 in 5 women reported going without needed health care in fall 2009 Similar figures reported having medical debt, which was common across all income groups “The Impacts of Health Reform on Health Insurance Coverage and Healthcare Access, Use, and Affordability for Women in Massachusetts,” S. Long and K Stockley, the Urban Institute; L. Birchfield and S. Schulman, Blue Cross Blue Shield of Massachusetts Foundation, June 2010, pgs. 3,4

4. Healthcare Coverage for Women Admitted to Substance Use Programs in MA in FY 2010 These services are covered by insurance. Insurance does not cover Long Term Residential Treatment in MA, which is paid mainly through BSAS dollars.

5. Healthcare Coverage for Women Civilly Committed to Substance Use Program in MA in 2010 In FY 10 there were 1,224 admissions to the Women’s Addiction Treatment Center - 18.1% (222) of them did not have insurance Note: Often insurers authorized a length of stay less than the actual length of stay in the program

6. Specific Problems for Women with SUDs More difficult for both men and women with addictions to remain covered throughout a year In MA, insurance covers only the following ASAM treatment levels of care, i.e., medically monitored inpatient treatment -detox (Level III.7), clinically managed residential treatment (Level III.5), and outpatient (Level I) Insurance covers number of days on an individualized patient basis, and the number of days varies, depending on insurance Insurance companies more interested in having “full service” agencies as part of their panels “Niche” programs may not be part of the panels of the insurance companies, i.e., programs that serve homeless women or women re-entry from C.J. programs Credential requirements may exclude or be a barrier for CADAC level clinician reimbursement Important outreach, engagement, and case management services are often not reimbursed Insurance companies may have varied practices that differ with SUD field treatment practices