It could seem like substance use disorders (SUDs), including opioid addiction are a new problem in Texas, but that’s not the case.
What is more recent are the full SUD benefits provided as part of the Texas Medicaid program. Really in just the last six years have Texans on Medicaid been able to access the full suite of SUD treatment options. Data indicate that more people in Medicaid have received treatment in the last six years, while per-patient costs have not increased.
America – and Texas – are in the midst of an opioid epidemic. Medicaid is the biggest provider of mental health and substance use disorder services in the United States. Even in states like Texas that have chosen to make very few adults eligible for Medicaid, Medicaid is still an important tool to meet SUD treatment needs. As Texas works to tackle the opioid crisis, it is critical that Texas Medicaid continues to provide SUD treatment services.
The Path to SUD Treatment in Texas
The 2009 Legislature looked at the specific issue of Texas adults in the Medicaid program who did not receive comprehensive SUD treatment services and as a result were having worse overall health outcomes, costing Texas Medicaid more to treat. The (perceived) problem was that Texas Medicaid covered only limited treatments related to substance use disorders for adults, and very few adults in Medicaid with a SUD diagnosis got treatment.
So the Legislature directed the Texas Health and Human Services Commission (HHSC) to use existing funds to set up a new, comprehensive substance use disorder (SUD) benefit for adults in Medicaid with the goal of providing better treatment and reducing overall program spending related to untreated SUD among adults.
As part of the change, the Legislature required HHSC to report whether adding the SUD benefit for adults increased overall Medicaid spending during 2011-2015, and whether it is cost effective for the benefit to remain part of program.
A November 2017 report by HHSC shows that adding the benefit did not increase the per-person cost of Medicaid services for people with an SUD diagnosis. More importantly the limited data on outcomes show meaningful improvements in people’s lives in terms of decreased homelessness, decreased arrests, and increased employment. Although it is hard to draw a direct link between access to SUD treatment services and improved outcomes, it is definitely a contributing factor.
The comprehensive SUD benefit was incorporated into Medicaid on January 1, 2011. The Medicaid SUD benefits available to adults and children today include:
- Assessment or evaluation by a chemical dependency treatment facility to determine an individual’s need
- Outpatient treatment, including individual and group counseling
- Residential treatment, long-term or short-term intensive treatment provided in a residential setting that can include detoxification, with the goal of helping an individual return to a community-based setting
- Medication Assisted Treatment (MAT), the use of medication combined with counseling and behavioral therapies
- Residential detoxification, an inpatient, safe place to go through detoxification
- Ambulatory detoxification, detoxification in an outpatient setting
Medicaid SUD benefit services must be provided by a chemical dependency treatment facility licensed and regulated by the state, except for MAT services, which either a licensed chemical dependency treatment facility or licensed physician can provide.
The share of Medicaid clients with an SUD diagnosis who access treatment has grown
HHSC findings show that the share of people enrolled in Medicaid with a SUD diagnosis who are getting treatment has increased. A 2015 Legislative Budget Board review of fiscal year 2011-2012 found that 2.2 percent of adults enrolled in Medicaid with an SUD diagnosis received Medicaid-funded SUD treatment. By 2015, nine percent of adults with an SUD diagnosis received treatment in Medicaid.
The added benefit has not raised per-person costs, because Medicaid costs of non-SUD services have declined for clients who access treatment
HHSC examined total costs for treated and non-treated adults in Medicaid with a SUD diagnosis, and SUD-only treatment costs. HHSC found that the treated population has lower average medical and pharmacy costs than the non-treated population, when SUD services costs are removed (See Table 1). In fact, HHSC’s report shows that the cost of SUD treatment, which was about $1,630 per-person on average in 2015, was offset by a roughly equivalent drop in all other Medicaid costs for people who got treatment.
Limited data on outcomes show meaningful improvements
Texas Medicaid does not require individual providers or health plans to report Medicaid outcome data related to SUD treatment, such as treatment completion rates, jail diversion, stable housing or employment. However, these types of outcome data are available for about half of people enrolled in Medicaid with an SUD diagnosis, because they also received SUD-related services through a federal block grant designed to supplement Medicaid services – the Substance Abuse Prevention and Treatment Block Grant (SAPT). Outcomes tracked by SAPT providers show that SUD treatment improved people’s lives once discharged (See Table 2). For example, after treatment, clients were less likely to be homeless or to get arrested, and more likely to be employed.
As Texas fights addiction in the midst of the opioid crisis, it will be critical for Texas Medicaid to continue providing SUD treatment services.