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.
This expert perspective reviews how Medicaid programs in Connecticut, Massachusetts and Rhode Island have engaged with commercial payers, providers, patients, advocates and other parties to create and adhere to multi-payer aligned measure sets. It describes the benefits to Medicaid agencies of participating in aligned measure set efforts, as well as tips and resources for Medicaid agencies intersted in measure alignment.
This expert perspective provides a high-level overview of key provisions included in the “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment” final rule that will facilitate enrollment and retention of Medicare Savings Program (MSP) coverage. MSPs are state-run programs that help low-income Medicare enrollees pay their Medicare premiums and/or cost-sharing. While the final rule’s effective date is November 17, 2023, CMS delayed compliance dates for most provisions until April 1, 2026, to reflect states’ competing priorities in light of the “unwinding” of the Medicaid continuous coverage requirement.