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