State policies governing outpatient substance abuse treatment services: Do they provide for necessary wrap-around services?

Background: Ancillary and wrap-around services such as childcare, transportation, and housing assistance have been significantly associated with treatment retention and outcomes. Further, a recent IOM report found significant problems in transitional care involving the coordination of services between substance abuse treatment facilities and needed community services.

Methods: Using primary legal research methods, we examined policy requirements governing outpatient treatment programs authorized (licensed/certified) by each state and state Medicaid policy requirements. The policies were analyzed using a dual-coder, qualitative content analysis approach. Confirmatory surveys of state authorizing and state Medicaid agencies were conducted to verify the legal data. Descriptive statistics, t-tests, and ANOVA techniques were used to analyze the policy data, including conducting comparisons of state authorization policy provisions and state Medicaid policy provisions.

Results: Preliminary data indicate that Medicaid policies are less likely to include wrap-around service requirements than are general state authorization (licensure/certification) policy requirements. Medicaid policies were more likely to require services that relate to maintaining treatment effects (e.g., relapse prevention, continuing care/after care, and discharge planning) than other wrap-around services. Many of the state authorization policies indicate that wrap-around services be included as an “option” rather than as a required service item.

Conclusions: Requirements for wrap-around services vary greatly by state, but are particularly lacking in Medicaid policies. This finding should be of concern to policy makers given that the populations served by Medicaid are often most in need of these services and, without them, are less likely to seek or remain in treatment.