Medicaid is part of the solution to the addiction crisis

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The United States is in the midst of an acute addiction crisis. A record 63,600 people died from a drug overdose in 2016 with 42,400 of these identified opioid-related deaths, and this number is growing. Medicaid is the largest provider of behavioral health services in the country, including substance use disorder (SUD) services.

Elected officials at the state and national levels have incorrectly faulted the Medicaid program and/or the expansion of Medicaid under the Affordable Care Act for causing or compounding the opioid crisis.  These assertions are based on faulty data and have been repeatedly debunked by Health Affairs and the Center on Budget and Policy Priorities, and in the national press by Politifact. In fact, Medicaid coverage is one of the most important tools states can use to address the addiction crisis.

Medicaid expansion increased coverage and access to SUD treatment services

The Affordable Care Act (ACA) allows states to expand their Medicaid programs to cover adults with incomes below 138% of the federal poverty level regardless of disability, extending health care coverage to far more adults with SUDs.

In Texas and 17 other states that have not expanded Medicaid, few adults qualify for Medicaid.  In Texas, an SUD diagnosis alone will not qualify a low-income adult for Medicaid.

The implementation of the ACA has decreased the number of uninsured individuals across the country, lowering the overall number of opioid-related uninsured hospitalizations. States that expanded Medicaid had a more significant decline. In Medicaid expansion states opioid-related uninsured hospitalizations dropped 79% between 2013 and 2015. States that did not expand Medicaid saw a more modest decline of 5% during the same time period.

Both expansion and non-expansion states observed significant declines in their overall uninsured rates, but Medicaid expansion has been especially critical for expanding coverage to adults with opioid use disorders (OUDs). Medicaid makes medications like buprenorphine and naloxone, prescribed to combat OUDs, more affordable. Medicaid spending for prescription drug treatment for OUDs more than doubled between 2011 and 2016 nationwide, as more low-income adults gained health coverage, many for the first time.

The expansion of Medicaid also improved access to SUD treatment services more broadly. After expanding Medicaid, Kentucky observed a 700% increase in people enrolled in Medicaid using SUD treatment services. This number also rose nationally, reducing the unmet need for SUD treatment by 18% across all states.

It is important to note that SUDs don’t occur in isolation, people with an SUD diagnosis also need access to physical and mental health services, and Medicaid expansion has been shown to help people get these services too. For example, in Ohio, 59% of people with OUD who gained Medicaid coverage under expansion also reported improved access to mental health care.

States are using Medicaid to address the opioid crisis

With more people eligible for Medicaid, states can significantly improve treatment for people with SUDs by improving Medicaid-covered services. Medicaid can be a sustainable funding source for SUD treatment providers, compared to limited and short-term block-grant funding.  California, Kentucky, Maryland, Massachusetts, New Hampshire, New Jersey and West Virginia have all implemented Medicaid initiatives for people with SUDs.  These states are providing services such as inpatient treatment or short-term residential treatment and evidence-based services like peer supports; they also are providing wraparound supports like housing and employment. Other states are seeking federal approval for similar proposals.

Experts dealing directly with the opioid crisis—public health and law enforcement officials, policy makers and policy experts—point to Medicaid expansion as critical in addressing the opioid crisis 

States that have not yet expanded Medicaid should take advantage of the opportunity to improve coverage and treatment for people struggling with opioid use and other SUDs. The newly appointed Texas House Select Committee on Opioids and Substance Abuse will start meeting this week and can evaluate the option of accepting federal dollars allocated to cover Texas low-income adults living in or near the poverty line. This option will ensure Texans have access to affordable health care that includes SUD treatment services. This will allow more currently uninsured adults to access needed SUD treatment and help the state tackle the impact of the opioid epidemic.

Source: Matt Broaddus, Peggy Bailey & Aviva Aron-Dine, Center on Budget and Policy Priorities, February 2018,  “Medicaid expansion dramatically increased coverage for people with opioid-use disorders, Latest data shows.” 

Monica Villarreal joined the Center in 2016 as a Hogg Mental Health Policy Fellow. She has previously worked on advocacy for disability issues and has policy experience from working at Disability Rights Texas and the American institutes for Research. Villarreal is a native of Monterrey Mexico and moved to Austin in 2010 to attend school at the University of Texas at Austin where she received a bachelor’s degree in Government and Latin American Studies and a Master’s of Public Affairs from the LBJ School of Public Affairs.

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