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West Virginia’s New Medicaid Waiver Promotes Medicaid Objectives

As we’ve explained, the Secretary of Health and Human Services can let states deviate from certain Medicaid rules when necessary to implement demonstration projects (also called section 1115 waivers) that further Medicaid’s core objectives, including improving coverage or beneficiaries’ health outcomes. West Virginia’s proposed waiver, which the Centers for Medicare & Medicaid Services (CMS) approved on October 6, falls squarely within the scope of these waivers because it tests a new approach to improve health and other outcomes for beneficiaries with substance use disorders (SUD). While West Virginia’s waiver will improve care, a number of other states have proposed harmful waivers that would impose barriers to coverage and care through work requirements, time limits, premiums, and other changes.

Expanding access to SUD treatment is an urgent goal for West Virginia, which had the nation’s highest drug overdose death rate in 2015, the most recent year for which we have data. West Virginia’s 2014 adoption of the Affordable Care Act’s Medicaid expansion improved residents’ access to physical and behavioral health care, which is critical for people with SUD. The state’s new waiver — which reflects 2015 CMS guidance explaining how states can use waivers to expand Medicaid services for people with SUD — will build on the success of its Medicaid expansion by:

  • Broadening the scope of SUD services that the state’s Medicaid program pays for, so the state can provide a full continuum of care. The waiver lets Medicaid pay for short-term residential treatment, which can be critical for people beginning recovery or rebounding from relapses — a common occurrence among people with SUD. It also expands beneficiaries’ options for evidence-based medication-assisted treatment (which combines medication with therapy) and adds coverage for peer recovery supports. Together, these reforms will help provide the community-based services and long-term recovery supports necessary to help people in all stages of SUD treatment and recovery.
  • Improving the quality of care. Along with increasing the scope of SUD services that Medicaid covers, the waiver aims to improve the quality of services. The continuum of care that West Virginia will provide is consistent with the American Society of Addiction Medicine Criteria — the nationally accepted treatment criteria for SUD. West Virginia will also work with CMS to create a system for monitoring quality and health outcomes.
  • Thoroughly evaluating the demonstration. Section 1115 waivers should test new strategies for providing coverage or delivering care that improve health outcomes. An independent third party will evaluate West Virginia’s demonstration, which will both determine whether it meets its objectives and help the state and the national SUD community learn more about creating a better SUD system of care.

Like West Virginia’s SUD waiver, section 1115 waivers should make Medicaid work better, not make it harder for people to get necessary care.