Final Opioid Package Should Include Several Medicaid Provisions That Improve Access to Care
But One Remains a Serious Concern
End Notes
[1] Hannah Katch, “House Bill Partially Repealing the ‘IMD Exclusion’ Would Do More Harm Than Good,” Center on Budget and Policy Priorities, June 20, 2018, https://www.cbpp.org/blog/house-bill-partially-repealing-imd-exclusion-would-do-more-harm-than-good.
[2] Matt Broaddus, Peggy Bailey, and Aviva Aron-Dine, “Medicaid Expansion Dramatically Increased Coverage for People with Opioid-Use Disorders, Latest Data Show,” Center on Budget and Policy Priorities, February 28, 2018, https://www.cbpp.org/research/health/medicaid-expansion-dramatically-increased-coverage-for-people-with-opioid-use.
[3] Foundation for a Healthy Kentucky, “Substance Use and the ACA in Kentucky,” December 2016, https://www.healthy-ky.org/res/images/resources/Full-Substance-Use-Brief-Final_12_16-002-.pdf.
[4] Center on Budget and Policy Priorities, “Essential Health Benefits Under Threat,” https://www.cbpp.org/essential-health-benefits-under-threat.
[5] Anna Bailey, “West Virginia’s New Medicaid Waiver Promotes Medicaid Objectives,” Center on Budget and Policy Priorities, October 24, 2017, https://www.cbpp.org/blog/west-virginias-new-medicaid-waiver-promotes-medicaid-objectives.
[6] Medicaid and CHIP Payment and Access Commission, “Report to Congress on Medicaid and CHIP, Chapter 4: Access to Substance Use Disorder Treatment in Medicaid,” June 2018, https://www.macpac.gov/publication/june-2018-report-to-congress-on-medicaid-and-chip/
[7] Christina Andrews et al., “Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform,” Health Affairs, Vol. 34 No. 5, May 2015, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2014.1330.
[8] Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6, §103, 115th Cong. (2018), https://www.congress.gov/115/bills/hr6/BILLS-115hr6ih.pdf.
[9] Congressional Budget Office (CBO), Preliminary Estimate of the SUPPORT for Patients and Communities Act, June 20, 2018, https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr6amendedby11578.pdf.
[10] Medicaid and CHIP Payment and Access Commission, “State Policies for Behavioral Health Services Covered under the State Plan,” June 2016, https://www.macpac.gov/publication/behavioral-health-state-plan-services/; Kaiser Family Foundation, “Medicaid’s Role in Addressing the Opioid Epidemic,” February 27, 2018, https://www.kff.org/infographic/medicaids-role-in-addressing-opioid-epidemic/.
[11] CHIP Mental Health Parity Act, H.R. 3192, 115th Cong. (2018), https://www.congress.gov/115/bills/hr3192/BILLS-115hr3192rfs.pdf.
[12] CBO, Cost Estimate for Opioid Legislation, June 6, 2018, https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/53949-opioid.pdf.
[13] Pew Charitable Trusts, “Medication-Assisted Treatment Improves Outcomes for Patients with Opioid Use Disorder,” November 22, 2016, http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-for-patients-with-opioid-use-disorder.
[14] Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6 §107(b), 115th Cong. (2018) as amended, https://www.congress.gov/115/bills/hr6/BILLS-115hr6ih.pdf. The requirement would extend from October 2020 through September 2025.
[15] Kaiser Family Foundation, “States Reporting Medicaid Coverage of Medication Assisted Treatment (MAT) Drugs,” https://www.kff.org/medicaid/state-indicator/states-reporting-medicaid-coverage-of-medication-assisted-treatment-mat-drugs.
[16] Jhamirah Howard et al., “The Importance of Medicaid Coverage for Criminal Justice Involved Individuals Reentering Their Communities,” Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, April 2016, https://aspe.hhs.gov/system/files/pdf/201476/MedicaidJustice.pdf.
[17] Jordan M. Braciszewski and Robert L. Stout, “Substance Use Among Current and Former Foster Youth: A Systematic Review,” National Center for Biotechnology Information, December 1, 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596821/.
[18] Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, as amended, op. cit.
[19] CBO, Preliminary Estimate of the SUPPORT for Patients and Communities Act, op. cit.
[20] Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, as amended, op. cit.
[21] CBO, Preliminary Estimate of the SUPPORT for Patients and Communities Act, op. cit.
[22] Department of Health and Human Services, Office of the Surgeon General, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” November 2016, https://www.ncbi.nlm.nih.gov/books/NBK424857/pdf/Bookshelf_NBK424857.pdf.
[23] Medicaid Reentry Act, H.R. 4005, 115th Cong. (2018), https://www.congress.gov/115/bills/hr4005/BILLS-115hr4005rfs.pdf.
[24] CBO, Cost Estimate for Opioid Legislation, op. cit.
[25] IMD CARE Act, H.R. 5797, 115th Cong. (2018), https://www.congress.gov/115/bills/hr5797/BILLS-115hr5797ih.pdf.
[26] Katch, op cit.
[27] For purposes of defining which individuals with opioid use disorders would have access to care in an IMD under the legislation, the bill defines “opioid prescription pain relievers” as including “fentanyl products.” It doesn’t specify whether illicitly manufactured fentanyl — in contrast with prescription fentanyl — would be included. Illicitly manufactured fentanyl is primarily responsible for the rapid increase in U.S. drug overdose deaths. See Centers for Disease Control and Prevention, “Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July-December 2016,” November 3, 2017, https://www.cdc.gov/mmwr/volumes/66/wr/mm6643e1.htm.
[28] Centers for Medicare & Medicaid Services, “Strategies to Address the Opioid Epidemic,” November 1, 2017, https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf.
[29] Paige Winfield Cunningham, “The Health 202: HHS chief pushes Trump opioid commission’s top recommendation,” Washington Post, March 2, 2018, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/03/02/the-health-202-hhs-chief-pushes-trump-opioid-commission-s-top-recommendation/5a9821f030fb047655a06a2e/.
[30] German Lopez, “The Deadlier Drug Crises That We Don’t Consider Public Health Emergencies,” Vox, October 27, 2017, https://www.vox.com/policy-and-politics/2017/10/27/16557550/alcohol-tobacco-opioids-epidemic-emergency.
[31] Alaska Department of Health and Social Services, “Health Indicator Report of Alcohol Consumption — Binge Drinking,” August 16, 2018, http://ibis.dhss.alaska.gov/indicator/view/AlcConBinDri.AK_US_time.html.
[32] MaryBeth Musumeci, “Key Questions About Medicaid Payment for Services in ‘Institutions for Mental Disease,’” Kaiser Family Foundation, June 14, 2018, https://www.kff.org/medicaid/issue-brief/key-questions-about-medicaid-payment-for-services-in-institutions-for-mental-disease/.
[33] CBO, Cost Estimate for Opioid Legislation, op. cit. The CBO cost estimate was prepared before adoption of the amendment adding cocaine to the list of substances triggering eligibility for residential treatment.