The Health 202: Republicans, Medicaid is a key way to tackle opioid abuse

Monday , March 12, 2018 - 11:50 AM

Paige Winfield Cunningham

(c) 2018, The Washington Post.

Here’s an irony as Capitol Hill Republicans consider how to tackle the nation’s opioid crisis: Doing it through Medicaid - the low-income health insurance program they spent last year attacking in Obamacare repeal efforts - is probably the quickest way to expand help to those who need it.

The health insurance program for low-income individuals covers a whopping four in 10 non-elderly adults with opioid addiction, according to the Kaiser Family Foundation. That’s why experts and dozens of activist groups agree that expanding counseling, medication-assisted treatment and other crucial addiction interventions for Medicaid patients would go a long way toward countering the country’s sweeping struggle with opioid overdoses.

“We hope as Republicans are thinking through their next steps on the opioid epidemic, they’re thinking about how Medicaid can reach these individuals,” Rebecca Farley, vice president of policy for the National Council for Behavioral Health, told me on Friday.

“From our perspective, Medicaid is clearly the best tool to expand access immediately through this existing infrastructure,” Farley added. “It’s so logical that Medicaid is the program used.”

The council and a bipartisan group of lawmakers are pushing hard for a bill doing just that. Last year, health clinics in eight states were allowed to access higher Medicaid payments in return for supplying a broad range of mental-health and substance-abuse services.

By meeting the requirements, those facilities could be designated as certified community behavioral health clinics. They could be compared to the popular community health centers Congress recently funded, which are also certified. Only these clinics would be focused on mental health and addiction services and existing community health centers could also add these services to offer a whole range of care.

To advocates who have long worried about a shortage of substance abuse services in the United States, these centers could fill a longstanding hole in the health safety net for low-income Americans. Of about 23 million Americans suffering from drug and alcohol disorders, just 11 percent get treatment at a specialty facility, according to the National Survey on Drug Use and Health.

“In the community, there is a huge disparity between physical health and mental health and addiction,” Sen. Debbie Stabenow, D-Mich., told me last week. Stabenow sponsored the 2013 Excellence in Mental Health Act, the measure that created the two-year pilot program.

Now Stabenow, Sen. Roy Blunt, R-Mo., a co-sponsor of her measure, and the House sponsors - Reps. Leonard Lance, R-N.J., and Doris Matsui, D-Calif. - are trying to convince their colleagues working on opioids legislation to expand the Excellence Act by adding clinic certification in 11 additional states that originally applied but were excluded from federal funding because of a lack of it.

The measure “would be a very helpful thing for people trying to deal with the opioid challenge,” Blunt told me.

Stabenow has her eye on $3 billion in opioid funding expected to be made available via the spending bill Congress must pass by March 23. It’s still unclear exactly how that funding will be divvied up, but some of it could go toward an opioid package being worked on by Rep. Greg Walden, R-Ore., chairman of the Energy and Commerce Committee.

“The fastest way to get comprehensive services out to patients would be to fully fund these 11 states who put together plans, who are ready to go,” Stabenow said.

But lawmakers and lobbyists told me privately they’ve run up against some GOP opposition to tackling opioid abuse through Medicaid, despite how well suited the program is for the task.

Medicaid was last year at the center of deep controversies over repealing and replacing the Affordable Care Act, as several GOP health-care proposals would have scrapped the law’s Medicaid expansion and enacted further changes to the program.

A Senate committee has even held a hearing to blame Medicaid, at least in part, for the opioid crisis. In January, Homeland Security and Governmental Affairs Committee Chair Ron Johnson, R-Wis., presided over a panel focused on whether the program gave more Americans access to opioid painkillers that were then distributed on the streets.

Johnson raised the issue to the Department of Health and Human Services last summer, writing in a letter to the agency that “the Medicaid expansion may be fueling the opioid epidemic in communities across the country. Because opioids are so available and inexpensive through Medicaid, it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits and stay hooked.”

Stabenow said she’s hoping Republicans view these new certified behavioral health centers in the same way they see community health centers, which enjoy broad bipartisan support, even though Congress took an unusually long time this year to extend their funding.

She also pointed to evidence of the program’s success in the eight participating states. The newly certified behavioral health centers reported they’ve been able to hire 1,160 new staffers including 72 psychiatrists and 212 employees with an addiction specialty or focus, according to NCBH.

Sixty-two percent of the clinics trained staff or community partners in administering naloxone, an overdose-reversing drug, and 81 percent either began offering medication-assisted treatment or expanded existing programs.

“People don’t think of [community health centers] as Medicaid,” Stabenow said. “We want them to think of behavioral health clinics like health clinics and really focus on the fact that we need a permanent way to deliver services in the community.”


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