States Pursue Medicaid Waivers and Expansions for Addiction Treatment

Four states including Maryland have received a federal waiver that allows them to use Medicaid dollars for addiction treatment facilities with more than 16 beds. While seven additional states are in the process of seeking the waiver, the federal government is encouraging more to apply as part of a push to expand access to residential addiction treatment to help deal with the nation’s opioid epidemic.

As reported on Stateline:

To boost the number of beds available for low-income residents, the federal government has granted California, Maryland, Massachusetts and New York a waiver of an obscure Medicaid rule that prohibits the use of federal dollars for addiction treatment provided in facilities with more than 16 beds. Seven other states — Arizona, Indiana, Illinois, Kentucky, Michigan, Utah and Virginia — are seeking similar permission.

In March, the Trump administration’s new Health and Human Services secretary, Tom Price, told governors that the agency would continue the Obama administration’s waiver policies for residential facilities with 16 or more beds.

The federal government is encouraging all states to seek a waiver of Medicaid’s residential treatment rule, but only if the care is offered as part of a comprehensive set of addiction services for low-income people.

In addition to offering inpatient treatment to patients who need it, state Medicaid addiction programs must include all available addiction medications, intensive outpatient therapy, recovery support services such as job training and housing, substance abuse prevention programs, case management and physical health services.

States also must prove that adding more residential treatment slots to the list of Medicaid treatment options will cost no more than continuing to prohibit it.

Medicaid expansion, plus the federal health law’s requirement that all insurance carriers reimburse for addiction services, along with the Mental Health Parity and Addiction Equity Act’s requirement that addiction treatment be paid for at the same level as medical and surgical services, together hold out the potential that billions of dollars for addiction treatment will be available in the years ahead.

Lifting the 16-bed limit will free even more federal money, making it possible for addiction treatment providers to expand their capacity, Ingoglia said. But, he said, it’s not likely to result in treatment on demand overnight.

California was the first state to receive a federal Medicaid waiver, in December 2015. More than two years later, California’s counties, which operate separate Medicaid programs, are still ironing out details on reimbursement rates and quality standards.

Maryland’s waiver program, approved in December, is slated to take effect July 1. In the meantime, the state will set licensing and staffing requirements, and develop reimbursement rates and billing rules.

For more information read the full article on Stateline.