In an effort aimed at the substance abuse epidemic that's disproportionately killing its residents, West Virginia is asking the CMS to approve a waiver that would expand treatment for Medicaid enrollees.
The state wants to expand the number of community-based and outpatient substance abuse providers, to offer residential treatment and to increase the availability of medication-assisted treatment, which combines the use of medications and behavioral therapy for the treatment of substance abuse disorders. It did not identify how much these efforts would cost.
It's unclear how the incoming Donald Trump administration will view this and other similar waivers but his administration picks have supported increased state control over Medicaid spending.
And West Virginia officials say something needs to be done quickly.
The state “has the highest rate of drug overdose deaths in the country, more than double the national average,” Cynthia Beane, acting commissioner of the Bureau for Medical Services for the state's Department of Health and Human Resources, said in a letter to the CMS last month.
There were about 39 drug overdose deaths per 100,000 West Virginia residents as of 2015, according to state data. Additionally, 31 of every 1,000 births in the state involve a baby born with neonatal abstinence syndrome, which is the result of substance abuse among pregnant women.
West Virginia's application represents a trend of states using Section 1115 waivers to focus their substance abuse payment and delivery system reform efforts and draw down additional federal funding to support reform efforts, according to a Manatt Health analysis on the issue.
Medicaid beneficiaries are at three to six times the risk of opioid overdose, the CMS reports.
In 2015, California received approval to expand its substance abuse offerings to include partial hospitalization services, residential treatment services and recovery services. Massachusetts got the green light for a similar waiver last year.
Trump's administration could deny West Virginia's waiver and terminate the waivers already granted. A standard provision in each waiver's terms and conditions allows either a state or the CMS to terminate a waiver at anytime.
Cindy Mann, a former Medicaid director at the CMS who is now a partner at the law firm of Manatt, Phelps & Phillips, said while that move would be uncommon even with a change in administration, "It could be done.”
U.S. Rep. Tom Price, Trump's pick for HHS and a strong opponent of the Affordable Care Act, wants state governments to determine how to spend their healthcare dollars.
During the campaign, Trump promised to give people struggling with addiction treatment options.
He committed to expanding incentives for states and local governments to use drug courts and mandated treatment and dramatically expand access to treatment and end Medicaid policies that obstruct inpatient treatment. However, few details were revealed and he hasn't again discussed the issue.
Trump's commitment to repealing the ACA, which expanded Medicaid coverage for millions of people, could worsen the nation's addiction woes. In the 31 states that have expanded, 1.2 million individuals with substance abuse disorders have gained access to coverage, according to Manatt. In non-expansion states, at least 1.1 million uninsured adults with substance use disorders would have access to coverage if their states were to expand.
