Rule Change Expands Addiction Treatment Options for Medicaid Patients

New Jersey one of two states to see immediate benefit

Vanessa Vitolo, who featured in Gov. Chris Christie's ad campaign for addiction services, has become what Christie called “the face of recovery” in the Garden State.
New Jersey is one of two states that could benefit from additional federal funds to support its efforts to expand access to drug treatment for Medicaid patients, a change advocates said is long overdue and could help tens of thousands of patients annually.

The new policy, announced Wednesday by the Centers for Medicare and Medicaid Services, was one high on the list of some 65 recommendations made by the White House commission on opioid addiction chaired by Gov. Chris Christie.

The panel held its last meeting Wednesday and posted its final report that evening. The 138-page document includes a detailed overview of the opioid epidemic, a review of existing programs and funding streams, and dozens of suggestions for federal departments and agencies to reduce the availability of addictive drugs, promote the development of other options, and significantly expand and improve treatment options in communities nationwide.

According to commission members’ comments, the report also calls for creating drug courts nationwide, deploying federal health workers to underserved regions, working with the pharmaceutical industry to develop less addictive options, and tapping a public-private partnership to fund a public education and anti-stigma ad campaign.

Much of the focus was on the news from CMS, which indicated it would reconsider a 50-year-old rule that largely prevents Medicaid from paying for inpatient addiction treatment at facilities with more than 16 beds — something President Donald Trump highlighted last week when he declared opiate addiction a public health emergency.

CMS |invited states to submit proposals for pilot projects testing this concept and also agreed to work with New Jersey and Utah to finalize a plan to use federal funds to pay for aspects of this inpatient treatment, starting in January.

Larger inpatient facilities

New Jersey received approval from the agency in July to place Medicaid patients in bigger inpatient facilities, as part of a larger regulatory waiver, but the state has been paying the full cost for this treatment, officials said. Nearly 41,000 Medicaid members were receiving substance-use disorder services as of September.

“This is a tremendous step forward in our efforts to aggressively combat the opioid epidemic and save lives,” Christie said.

“I think it’s huge for New Jersey,” agreed Robert J. Budsock, president and CEO of Integrity House, a well-known treatment provider. “If you have someone who is uninsured, or on Medicaid, there are not many residential treatment beds available,” he said.

Budsock praised the governor for leading the charge to address a regulatory restriction — the so-called IMD exclusion — little known outside the recovery world. The rule stems from Medicaid’s creation, in 1965, and the federal government’s fear it would bankrupt the program if funding could be used to pay for long-term care at “institutes for mental disease,” generally large, state-run facilities at the time.

While Budsock would prefer to see the IMD exclusion eliminated entirely, he called the CMS announcement “a good start,” adding that it “is going to result in more, hopefully, residential treatment beds and the use of the additional funding to expand all (treatment) services.”

A welcome change

The CMS change was also welcomed by Vanessa Vitolo, a New Jersey resident featured in the governor’s ad campaign for addiction services who has become what Christie called “the face of recovery” in the Garden State.

Vitolo told the White House panel that she had tried to enter treatment several times but, “it was very difficult and I would start using again before I completed the process” of securing a bed at a facility that took Medicaid, her only insurance coverage.

Expanding treatment options and ensuring addicts have access to these facilities were key themes in the draft report, released in August by the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, which Trump appointed in March. The panel is part of Trump’s effort to fulfill a campaign pledge to address the epidemic, which federal officials said now kills an average of 175 Americans daily. In New Jersey, nearly 2,000 people lost their lives to addiction in 2016.

The commission’s initial top recommendation — naming opioid addiction a national emergency — was enacted just last week, when the president declared the situation a public health emergency. The order gave federal health officials greater latitude in battling the disease, but it did not include new funding, something critics said gives the policies that follow little weight.

Defending Trump

Christie, who has made addressing opiate addiction a priority in his final year in office, defended the president’s actions during Wednesday’s meeting and said he urged Trump to use the emergency declaration mechanism he chose. “But now its incumbent upon Congress to step up and put the money in the Public Health Emergency Fund,” Christie said, referring to the traditional funding source for health related emergencies, which reportedly has a $57,000 balance.

“The commission, and the president, are now handing the baton to Congress,” Christie continued. “They must step up and appropriate the funds.”

There is no formal price tag attached to the panel’s initial recommendations. But former U.S. Rep. Patrick Kennedy (D-RI), an advocate for recovery who now lives in New Jersey and also served on the White House commission, predicted there was at least a $10 billion need — less than half of what Congress committed to fight the AIDS epidemic, he noted.

The initial report also calls for federal funding to expand medication-assisted treatment, through which prescriptions are used to help manage addiction, better education of opiate prescribers, and legislative changes to encourage the use of naloxone, or Narcan, which can reverse an opioid overdose. It also recommends better sharing of prescription data among states and increased efforts to combat drug trafficking.

Christie also warned that, even with money, implementing the recommendations will take some time. “There will be fits and starts and there will be impatience,” he said, adding that he had faith in Trump’s leadership on the issue. “I am confident that he will plow ahead,” Christie said.