A Long Overdue Overhaul: New Medicaid Substance Abuse Benefit to Expand Treatment Options

A Long Overdue Overhaul: New Medicaid Substance Abuse Benefit to Expand Treatment Options

A long-standing barrier facing lower-income Americans needing treatment for drug and alcohol use disorders has finally been removed…at least for now. Starting this month, states across the country – including Virginia – have begun to roll out an expansion in Medicaid coverage that will help make increasingly in-demand substance abuse care and services a reality for those who depend on Medicaid to pay for critical health services.

Medicaid and Substance Abuse Recovery

The new benefit – which grew out of key provisions and funding made available by the Affordable Healthcare Act and which assumed greater urgency as the opioid epidemic wore on – helps Medicaid patients with a drug or alcohol problem in a couple of important ways. First, it lifts a previously narrow restriction on which Medicaid beneficiaries are eligible for substance abuse services – and the kinds of facilities where they could go for help.

Secondly, it increases the reimbursement rates from Medicaid to providers so that more facilities can accept it as payment for services. The result: a far wider array of drug and alcohol rehabilitation services, including outpatient and residential treatment, case management, and medication assisted treatment is now within reach for those on Medicaid.

Medicaid and Medicare in the U.S.

Medicare and Medicaid are both Federal programs but operate in large part by making funding available to states who then allocate monies to address the salient needs of special populations (elderly, indigent, low income, etc.) in their areas.

So far, approximately 31 states – Virginia among them – have been working implement the new substance abuse benefit. And most in the addiction treatment arena agree that the expanded benefit is both long overdue, and very welcome, at what is undoubtedly a critical time.

Overdoses of Opiates on the rise

Opiate overdoses in the U.S., which have been steadily increasing since the early 2000’s, recently accounted for 33,000 fatalities per year – surpassing auto accidents as a leading cause of death. In Virginia, nearly 1,000 people overdosed on opiates in 2014, a 38 percent increase over the span of two years.

Those increases in opioid misuse alone cost the state around 26 million to address. And it has been shown that Medicaid beneficiaries may be at a heightened risk to develop an opioid addiction or dependency.

According to the Centers for Medicare & Medicaid services, Medicaid beneficiaries are prescribed painkillers at twice the rate of non-Medicaid patients and are six times more likely to experience an overdose.

Virginia taking new steps to broaden addiction services

Virginia’s new program, known as the Addiction and Recovery Treatment Services benefit – or ARTS – was prompted by a series of recommendations submitted by the Governor’s Task Force on Prescription Drug and Heroin Abuse to Gov. Terry McAuliffe in 2015. Like many other states, Virginia’s push to expand the way Medicaid would support drug treatment was influenced in no small part by the way the opiate epidemic has impacted demand for treatment in the last several years.

But states rolling out the new Medicaid benefit were also responding to older Medicaid restrictions that hadn’t changed for years and don’t seem to make sense anymore. For example, Medicaid reimbursement rates for substance abuse treatment have not increased since 2007 and even that increase did nothing to put a dent in the cost of quality, longer term addiction treatment.

So, in recent years, many individuals with Medicaid simply couldn’t go to treatment because their health benefits didn’t pay enough. Making matters worse, due to old restrictions still on the books, inpatient detox and residential treatment have for many years been available only to pregnant Medicaid beneficiaries or those younger than 21 – at treatment facilities with less than 16 beds. The new substance abuse benefit lifts those limitations and makes full treatment available to all Medicaid and FAMIS (Family Access to Medical Insurance Security) beneficiaries.

Accessibility to ARTS benefits

More than a million people covered by Virginia Medicaid and FAMIS will now have access to the ARTS benefit. And the vast majority of residential substance abuse facilities in the state, including Bridging the Gaps, have signed up to take part in the program – greatly expanding the network of providers in place.

Virginia Department of Medical Assistance Services’ data shows that, before the ARTS program was introduced, there were no residential treatment, partial hospitalization, or office-based opioid treatment providers within Medicaid’s network in central Virginia.

Medicaid coverage to widen sheds hope

The expansion of Medicaid coverage in the substance abuse arena is an exciting new development that promises to make critical treatment more readily available to many in need. But some worry that new developments in Washington – namely a GOP effort to repeal and/or replace Obamacare – could threaten state programs just as they are about to take hold and pay off.

While President Trump pledged to more effectively address the opiate epidemic in part by working to “end Medicaid policies that obstruct inpatient treatment,” a recent healthcare plan that experts say would have rolled back funding and political will to adequately support Medicaid substance abuse efforts was under serious consideration until just last month.

That proposal, dubbed the American Health Care Act, was ultimately rejected by key congressionals and pulled from further floor consideration, but some worry that threats to Medicaid expansion are not over.

The future of Medicaid and Bridging the Gaps

Only time will tell how the new substance abuse benefit will weather a strong Republican effort to change the governing healthcare law, but in the meantime, substance abuse treatment organizations like ourselves look forward to being able to more fully serve those in need. Bridging the Gaps is currently finalizing arrangements to be a provider within Virginia’s Medicaid substance abuse network and will be taking new clients in the immediate future. If you have a drug or alcohol problem and are on Medicaid, give us a call at 540-535-1111. We’d love to help you start your journey to recovery!


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