Addiction treatment has been a hot topic in the news over the past few months, from the opioid crisis taking over states and communities, to the release of a new implant that administers buprenorphine (see The Opioid Epidemic: By the Numbers and Long-Acting Opioid Treatment Could Be Available In A Month). But, in addition to these mainstream news stories, there have also been important policy changes in Medicaid addiction treatment – states can now receive federal reimbursement for services provided at institutions of mental diseases (see The End Of IMD Exclusion?).
In an attempt to get a bead on the addiction treatment in Medicaid, a couple of weeks ago OPEN MINDS completed a comprehensive review of addiction treatment benefits covered by Medicaid (see The Issue Of Limited Residential Addiction Treatment Coverage Under Medicaid). What we found was that the benefits available to Medicaid beneficiaries varied widely by state – with some states not covering addiction treatment benefits for all Medicaid populations. Only one state, California, had decided to expand residential treatment in institutions for mental disease (IMDs) to all Medicaid enrollees. The state’s Drug-Medi-Cal waiver (which was approved in August 2015) also allows counties to provide additional addiction treatment services, such as recovery support services and expanded medication assisted treatment (MAT). Thus far one county, San Mateo, has an approved implementation plan and new services will be provided after contracts are signed with provider organizations to provide the expanded services (see County Implementation Plans).
Since then, at least five states have made some major moves to expand their addiction treatment benefits, including two states that are applying for residential treatment benefits for all Medicaid enrollees in IMDs; two states that are expanding the benefit available; and two states that are extending addiction treatment benefits to all Medicaid populations. What states are expanding their benefits for consumers in 2016 and beyond?
Maryland – Maryland Medicaid does not currently cover residential treatment for addiction in any capacity, but that should change soon. Maryland is in the process of renewing its 1115 waiver, HealthChoice, and as part of the renewal, the state is requesting matching funds for individuals receiving addiction treatment in IMDs. If approved by the Center for Medicare and Medicaid Services (CMS), reimbursement for residential treatment will go into effect on July 1, 2017. The state tried to submit an IMD amendment to their waiver in July 2015, but were denied by CMS (see Maryland HealthChoice Program §1115 Waiver Renewal Application).
Massachusetts – Like Maryland, Massachusetts is also in the process of renewing their 1115 waiver, MassHealth, and through the waiver, the state is expanding many addiction treatment benefits for Medicaid enrollees. New services include transitional support and residential rehabilitation services. With the addition of residential rehabilitation as a Medicaid benefit, the state is planning to add more than 850 addiction treatment beds. Additionally, the state will expand the scope of its existing Opioid Treatment Centers from methadone treatment programs only to include provision of buprenorphine and naltrexone. If approved by CMS, the changes to benefits will be implemented in FY 2017. The state expects to have the additional residential treatment beds available in FY 2018 (see Massachusetts Medicaid To Expand Addiction Treatment Benefit).
New Jersey – Just last month, New Jersey expanded their comprehensive addiction treatment benefits (outpatient, residential, detoxification in a non-hospital setting, partial hospitalization and MAT) to cover all Medicaid populations – however, the state is still requiring prior authorization for all services (see Behavioral Health Service Rates; Substance Use Disorder Benefit and Substance Use Disorder (SUD) Benefit for Standard Medicaid Recipients). Previously, addiction treatment benefits were only available to the Medicaid expansion population (childless adults with income up to 138% of the FPL) as required under federal law. This expanded benefit package went into effect on July 1, 2016.
New Hampshire – Like New Jersey, New Hampshire has expanded their comprehensive addiction treatment benefits (outpatient, residential, detoxification in a non-hospital setting, partial hospitalization and MAT) to cover all Medicaid populations, effective July 1, 2016. Prior to this change, addiction treatment benefits were only available to the Medicaid expansion population. This expansion of benefits is part of the state’s “Building Capacity for Transformation” 1115 waiver demonstration project (see New Hampshire Medicaid Waiver Project To Focus On Integrated Delivery Of Behavioral Health Care).
Virginia – Virginia is looking to completely transform their addiction treatment benefit through a 1115 waiver. The new waiver adds coverage of inpatient treatment, peer support, and residential treatment (including services in an IMD). Additionally, the state is carving-in community-based addiction treatment to the state’s managed care organizations (MCOs) and increasing the reimbursement rates for many addiction treatment benefits by 400%. The state’s 1115 waiver is open for public comment until August 1, 2016. If approved by CMS, the new addiction delivery system will go into effect on April 1, 2017 (see Concept Paper: 1115 Waiver for Addiction Treatment Services and Medicaid Substance Use Disorders (SUD) Services Opportunity for Public Comment).
These expansions represent a shift in thinking about addiction treatment and the necessity of these services. We can expect, as addiction treatment continues to get more attention and the opioid crisis continues to make headlines, that more states will move towards a comprehensive addiction treatment benefit. For provider organizations, these benefit expansions for consumers represent a new opportunity. More consumers with addiction issues will be able to get treatment through Medicaid – opening up the potential to implement or expand new service lines and provide addiction benefits to new populations. In a market built on value and “whole person” health care, addiction is a big issue for consumers that has been undeserved in many states. For provider organizations not operating in the addiction treatment space, these benefit expansions pave the way for new collaborations and partnerships with other organizations as part of a comprehensive care coordination strategy.
For more on implementing new service lines at your organization, check out Need Financing For Your Next Big Service?, Four Keys To Success With MCO Contracting and Diversification = Market Research + Math. And for more on how the changes to California’s Medicaid addiction treatment system are progressing, join us at The 2016 OPEN MINDS California Management Best Practices Institute on August 24-25 in San Diego, California. In the session “Expanded Coverage For Addiction Treatment: Finding The Opportunities With The Drug Medi-Cal Organized Delivery System,” we’ll discuss the changes in the addiction treatment market with Richard Louis, III, Senior Associate, OPEN MINDS; Sandra Naylor Goodwin, Ph.D., MSW, President & CEO , California Institute for Behavioral Health Solutions (CIBHS); Michael Hutchinson, MFT, Director, Quality Improvement and Data Support, Substance Use Treatment System Division, Santa Clara County Health and Hospital System; and David Lisonbee, President & CEO, Twin Town Treatment Centers.