Wednesday Wonk: Federal Medicaid Bills in House Opioid Package

On Wednesdays, West Virginians Together for Medicaid will feature a blog for Medicaid Policy know who you are!

With help from our national allies, we will feature a deeper dive into federal and state Medicaid proposed policy changes and bills.

Today we are featuring a new issue brief by the Center on Budget and Policy in Washington, DC that takes a look at the Medicaid bills that are part of the package of legislation addressing the opioid epidemic that the House is considering over the next two weeks. 

While not a comprehensive approach to the opioid epidemic, several of the Medicaid provisions likely to reach the House floor would take small but positive steps toward increasing provider capacity, ensuring a full continuum of care, and preventing people with SUDs from experiencing gaps in treatment.  But the costliest of the bills, which would allow Medicaid to pay for institutional care, goes in the opposite direction: it could undermine current state and federal efforts to ensure that people with SUDs have access to the full continuum of SUD treatment.  READ MORE ABOUT THIS NEGATIVE PROPOSAL

Read the full report

From the Center on Budget and Policy issue brief, "Assessing the House Opioid Package's Medicaid Bills" --

"It would partially repeal a longstanding policy — known as the Institutions for Mental Disease (IMD) exclusion — prohibiting the use of federal Medicaid funds for care of patients ages 21 to 64 receiving SUD treatment in facilities with more than 16 beds. Repealing or partially repealing the IMD exclusion risks doing more harm than good.

The legislation would partially repeal the IMD exclusion for five years but would only allow states to use federal Medicaid funds to pay for care delivered to people with opioid use disorders (OUD) in IMDs; it wouldn’t allow them to use those funds to pay for residential treatment for Medicaid beneficiaries with other SUDs. Nor would it require states to increase investments in community-based services, which are badly needed in many states. These services are important both to people not treated in residential facilities and to people who leave residential treatment and need community-based services to continue their treatment and recovery and get treatment quickly in the event of a relapse.

Guidance issued by the Obama and Trump Administrations provides an alternative, better approach to relaxing the IMD exclusion for SUD treatment, which makes repeal unnecessary and likely counterproductive. The guidance allows states to obtain limited waivers from the exclusion if they also take steps to ensure that people with SUDs have access to other care they need, including preventive, treatment, and recovery services, all provided in accordance with evidence-based standards. Eleven states have SUD waivers [including West Virginia], and 12 others have proposals pending; the Trump Administration has encouraged other states to apply.

In contrast to the bill’s extremely limited approach, SUD waivers allow states to address the full range of SUDs, which vary by state and over time and by demographic group.  For example, alcohol-related deaths are much more common than opioid overdose deaths, both nationally and in certain states such as Alaska, where the rate of alcohol-related mortality is more than double the national rate."

West Virginians Together for Medicaid