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The 21st Century Cures Act, a bipartisan measure that President Obama signed this week, provides small grants to reduce incarceration for people with mental illness and $1 billion to address the opioid crisis. Nevertheless, Medicaid remains the major funding source for states to treat mental illness and substance use disorders, and plans by the incoming Republican majority to cut Medicaid funding by both repealing Medicaid expansion under the Affordable Care Act (ACA) and restructuring the program would jeopardize access to substance abuse and mental health treatment.
Cures Act will help states test new ways to reduce recidivism and re-incarceration among people with mental health problems. It also can support specific services that Medicaid doesn’t pay for, such as staff training and technical assistance helping communities implement best practices. But Cures Act funding alone is far from sufficient.
Its grants are short-term, only two years in the case of opioid funding. Providers, especially those in rural areas, can’t survive on ad hoc and unreliable grant funding that’s distributed through competitive applications or awarded to states via a formula. They need the financial stability Medicaid provides.
Medicaid, by contrast, is the nation’s largest payer for treatment services for people with mental illness and substance use disorders. It provides a consistent source of revenue for behavioral health providers without which the current shortage of behavioral health providers would worsen. Medicaid provides access to essential outpatient opioid abuse treatments, such as medication assisted treatment and overdose reversal drugs. As we’ve explained, expanding Medicaid through the ACA further helped states meet behavioral health needs in multiple ways, by:
- Reducing the unmet need for mental health and substance use disorder treatment;
- Improving health outcomes; and
- Improving state and local behavioral health programs without new costs.
Deeply cutting Medicaid funds by repealing the Medicaid expansion under the ACA and by converting Medicaid to a block grant or per capita cap would jeopardize ongoing efforts to stem the opioid crisis and undermine gains that new funding could achieve. Without Medicaid, many people struggling with opioid addiction or mental illness would be forced to forgo treatment.
The Cures Act’s benefits, said Rep. Frank Pallone, ranking Democrat on the House Energy and Commerce Committee, which oversees Medicaid, “will be far outweighed by the catastrophic harm caused to individuals with mental illness if the Republicans move forward with their radical plans to repeal the Affordable Care Act, [and] block grant Medicaid.”