Medicaid: The Linchpin in State Strategies to Prevent and Address Opioid Use Disorders
April Grady, Patricia Boozang, Deborah Bachrach, Adam Striar, and Kevin McAvey, Manatt Health
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. The federal government has responded to the crisis by declaring a public health emergency and making over $500 million of OUD-targeted funding available to states last year. While critical, these dollars (and the programs they fund) pale in comparison to the scale and scope of resources the Medicaid program brings to states to combat the opioid epidemic and other substance use disorders (SUD). Indeed, today, Medicaid covers more than 1 in 3 people with an OUD, and program spending for people with an OUD in 2013 (before Medicaid expansion in many states) was more than $9 billion. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
Following guidance released earlier this fall, on November 29, 2018 the Centers for Medicare & Medicaid Services (CMS) released a discussion paper entitled “Section 1332 State Relief and Empowerment Waiver Concepts” to provide states with additional guidance and information about four types of waiver concepts that could be approved under the earlier guidance. This expert perspective reviews the four waiver concepts proposed in the discussion paper and the potential opportunities they present for states.
On November 9, 2018, the U.S. Department of Health & Human Services (HHS) published a proposed set of new standards for the Affordable Care Act (ACA) marketplaces. The preamble describes these standards as part of HHS’ efforts to improve marketplace “oversight and financial integrity.” If finalized, they will be effective for the 2020 plan year. HHS is asking for comments on the proposal by January 8, 2019.
On Wednesday, August 22, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter (SMDL) memorializing CMS policy for ensuring that Section 1115 waivers remain budget neutral to the federal government. The SMDL describes CMS policy for calculating budget neutrality both for new waivers and for extensions of existing waivers with the implications for states with existing waivers, and those seeking to apply for waivers, discussed in this expert perspective.
