Repealing Medicaid Exclusion for Institutional Care Risks Worsening Services for People With Substance Use Disorders
End Notes
[1] Centers for Disease Control and Prevention, “Drug Overdose Death Data: 2015-2016 Death Increases,” https://www.cdc.gov/drugoverdose/data/statedeaths.html.
[2] MaryBeth Musumeci, “Key Questions about Medicaid Payment for Services in “Institutions for Mental Disease,” Kaiser Family Foundation, April 12, 2018.
[3] “Discussion Draft: A bill to amend title XIX of the Social Security Act to allow states to provide under Medicaid services certain individuals with substance use disorders in institutions for mental diseases,” April 5, 2018, http://docs.house.gov/meetings/IF/IF14/20180411/108092/BILLS-115pih-ProvideIMDServicesUpto90DaysforMedicaidBeneficiarieswithSUD.pdf.
[4] The original definition included a state option to pay for IMD care for individuals over age 64; in 1972, Congress added a state option to pay for IMD care for individuals under age 21.
[5] GAO-17-652, fn. 2.
[6] Section 1905(a)(B) of the Social Security Act.
[7] Centers for Medicare & Medicaid Services, “State Medicaid Manual,” accessed March 16, 2018, https://www.cms.gov/Regulations-and-Guidance/guidance/Manuals/Paper-Based-Manuals-Items/CMS021927.html.
[8] Government Accountability Office, “States Fund Services for Adults in Institutions for Mental Disease Using a Variety of Strategies,” August 9, 2017, https://www.gao.gov/products/GAO-17-652.
[9] Centers for Medicare & Medicaid Services, “New Service Delivery Opportunities for Individuals with a Substance Use Disorder,” July 27, 2015, https://www.medicaid.gov/federal-policy-guidance/downloads/smd15003.pdf.
[10] Centers for Medicare & Medicaid Services, “Strategies to Address the Opioid Epidemic,” November 1, 2017, https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf. States can also draw down federal funding for SUD services provided in IMDs in two other ways. Medicaid managed care organizations can provide IMD care “in lieu of” covered services or settings if they are medically appropriate and budget-neutral. Of the 39 states that operate managed care programs, 26 report that they provide or plan to provide IMD services through this pathway. States can also make limited Disproportionate Share Hospital payments to IMDs. 42 CFR 438.6(e); Government Accountability Office, “States Fund Services for Adults in Institutions for Mental Disease Using a Variety of Strategies.”
[11] The waiver defines peer recovery support as services “designed and delivered by individuals in recovery from substance use disorder (peer recovery coach) to provide counseling support to help prevent relapse and promote recovery.”
[12] “What Are the ASAM Levels of Care?,” Continuum, May 13, 2015, https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/.
[13] The ten states with waivers are California, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, New Jersey, Utah, Virginia, and West Virginia. The 11 states with pending waivers are Alaska, Arizona, Illinois, Kansas, Michigan, North Carolina, New Mexico, Pennsylvania, Vermont, Washington, and Wisconsin.
[14] Paige Winfield Cunningham, “The Health 202: HHS chief pushes Trump opioid commission’s top recommendation,” Washington Post, March 2, 2018, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/03/02/the-health-202-hhs-chief-pushes-trump-opioid-commission-s-top-recommendation/.
[15] Addiction Center, “Cost of Drug and Alcohol Rehab,” https://www.addictioncenter.com/rehab-questions/cost-of-drug-and-alcohol-treatment/.
[16] Peggy Bailey, “Better Integration of Medicaid and Federal Grant Funding Would Improve Outcomes for People with Substance Use Disorders,” Center on Budget and Policy Priorities, April 9, 2018, https://www.cbpp.org/research/health/better-integration-of-medicaid-and-federal-grant-funding-would-improve-outcomes-for.
[17] “Discussion Draft.”
[18] The bill would require a state that adopts this option to at least maintain the number of IMD beds and the level of state spending on IMD services as of the date of enactment or the date the state adopts this option, whichever is higher.
[19] “Discussion Draft: A bill to amend title XIX of the Social Security Act to allow states to provide under Medicaid services certain individuals with substance use disorders in institutions for mental diseases,” April 24, 2018, https://docs.house.gov/meetings/IF/IF14/20180425/108241/BILLS-115pih-LimitedrepealoftheIMDExcl.pdf.
[20] In Olmstead, the Supreme Court found that the unjustified institutionalization of people with disabilities violates the Americans with Disabilities Act (ADA). Although the ADA’s anti-discrimination provisions do not apply to individuals currently using illegal drugs, the ADA does protect people who previously used illegal drugs and people with mental health-related disabilities. See MaryBeth Musumeci, “Key Themes in Medicaid Section 1115 Behavioral Health Waivers,” Kaiser Family Foundation, November 2017, http://files.kff.org/attachment/Issue-Brief-Key-Themes-in-Medicaid-Section-1115-Behavioral-Health-Waivers, and MaryBeth Musumeci, “Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision,” Kaiser Family Foundation, June 2014, https://www.kff.org/medicaid/issue-brief/olmsteads-role-in-community-integration-for-people-with-disabilities-under-medicaid-15-years-after-the-supreme-courts-olmstead-decision/.
[21] Elizabeth O’Brien, “Here’s What It Would Cost to Fix the Opioid Crisis, According to 5 Experts,” TIME, November 27, 2017, http://time.com/money/5032445/cost-fix-opioid-crisis/.
[22] Ellen Bouchery, Rebecca Morris, and Jasmine Little, “Examining Substance Use Disorder Treatment Demand and Provider Capacity in a Changing Health Care System: Initial Findings Report,” U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, September 2015, pp. 52-53, https://aspe.hhs.gov/system/files/pdf/203761/ExamSUD.pdf.