Director of the Health Integration Project
The President and Congress more than doubled grant funding to address the opioid epidemic between 2017 and 2018 but, while opioid- and overall drug-related death rates didn’t continue rising dramatically as they had over several prior years, 2018 preliminary data suggest they’ve flattened rather than dropped. Further progress will require federal, state, and local efforts that maximize Medicaid and boost grant funding to adequately provide wraparound services that Medicaid alone can’t cover. A new bill from Rep. Elijah Cummings and Senator Elizabeth Warren, which includes provisions to better integrate Medicaid and federal grant funding, could boost that progress.
The most effective treatment programs for substance use disorders (SUDs) combine mental health and substance use treatment services with other supports, including housing, child care, vocational supports, educational services, legal services, and financial assistance. Grant funding can’t make these programs widely available because it’s too small to meet the need, because it’s funded through the appropriations process (which means that it isn’t guaranteed from year to year), and because much of the grant funding is too narrowly targeted. Providers are hesitant to expand services and include other supports if federal funding is only guaranteed for a year or two. New site locations take years to build and providers find it hard to attract high-quality staff when funding is precarious. Moreover, states report a need for more flexible federal funding to let them respond to drug misuse challenges beyond the opioid epidemic. For example, methamphetamine and cocaine use are rising in some communities.
Medicaid, which isn’t subject to annual appropriations and guarantees coverage to everyone who is eligible and applies for it, can work with grant funding to expand access to effective treatment. The Affordable Care Act’s Medicaid expansion has significantly increased insurance coverage for people with low incomes and substance use disorders in the 37 states (including Washington, D.C.) that have adopted the expansion. Medicaid can cover a significant share of substance use treatment and recovery services, including clinical care, counseling, and peer support services. With guaranteed funding, providers can predict revenue and make informed business decisions about providing services, expanding staff, and opening new locations. Medicaid can also respond to changing trends in drug use at the community level.
Federal, state, and local governments could make more progress on the opioid epidemic and provide substance use services more broadly by using grant funding to complement what Medicaid provides, rather than relying on grants to fund substance use treatment that Medicaid can finance. For instance, grant funding can fund wraparound supports, like housing, that Medicaid doesn’t cover and one-time costs such as improving an organization’s data systems or training staff.
The Cummings-Warren bill would add $100 billion over ten years to substance use treatment and recovery services, regardless of state or local drug use trends, and ensure that communities use Medicaid as the foundation for funding services so that grant funding helps pay for a wider array of services. The bill would also expand funding for Medicaid agencies to boost providers’ capacity to meet the requirements for participating in Medicaid.
As the Cummings-Warren bill does, new legislation to address the opioid epidemic and broader substance misuse must maximize Medicaid and allow grant funding to pay for the services that Medicaid doesn’t cover, such as job skills training, life skills counseling, child care, and housing. That will give people with SUDs better access to the full array of services they need to stabilize their lives.