Health care reform will dramatically increase Medicaid enrollment for working age adults by making Medicaid coverage available universally to low-income adults without regard to pregnancy, disability status or the presence of children in the household. It is important to understand the likely health care needs of the population that will be newly qualified for Medicaid to inform benefit design, forecast service utilization and expenditures, and to identify areas where provider network capacity is likely to be particularly constrained. This paper focuses on what we know about the likely level of substance abuse treatment need in the Medicaid expansion population in Washington State, based in part on information about jail populations and clients currently receiving state-funded medical assistance who likely will be a key subset of the Medicaid expansion population. In addition, this report describes how health care reform creates strong financial incentives for states to focus on providing services that slow the progression of chronic disease conditions that result in disability, and the important role of substance abuse treatment in this area. The enhanced federal match for the Medicaid expansion population will be a “game changer” that shifts financial incentives away from facilitating enrollment in federal disability programs (for states with state funded general assistance programs), and towards improving the health status of Medicaid enrollees who have not yet become disabled.
