Report Details Medicaid Strategies for Combating Opioid Addiction Epidemic

A new report from the Robert Wood Johnson Foundation and Manatt Health details the role Medicaid can play in fighting the nationwide opioid epidemic. The authors explore a variety of strategies that state Medicaid programs can use to prevent and treat opioid use disorders and other substance use disorders (SUDs), including tailoring benefit designs, implementing Health Homes targeted towards individuals with opioid use disorders and other SUDs, and leveraging Medicaid’s purchasing power to expand use of best practices in SUD prevention and treatment. The report also details how states can use 1115 waivers to draw down additional federal funding to transform the payment and delivery of SUD services. For example, under an 1115 Delivery System Reform Incentive Payment (DSRIP) waiver, New Hampshire is creating regional integrated networks of physical health, behavioral health, and social service providers. Through 1115 waivers, states can also institute strategies to strengthen behavioral health workforce capacity; implement targeted clinical programs for beneficiaries with SUDs such as community re-entry for justice-involved populations and school-based substance abuse screening; expand SUD benefits beyond a state’s standard Medicaid benefit package or to populations that would not otherwise be eligible for Medicaid; and increase access to care management and care coordination services. The report’s authors conclude that Medicaid is “the most powerful vehicle” states have to fund and deliver treatment and prevention services for opioid addiction, particularly for states that have expanded Medicaid, noting that the expansion population has a higher prevalence of SUDs than those eligible for traditional Medicaid.

Florida: Lawsuit Settlement Aims to Increase Medicaid Children’s Access to Services

A U.S. District Judge approved a settlement agreement that requires Florida to establish, through its contracted Medicaid managed care organizations, an “Incentive Plan” under which pediatricians and obstetricians have a “reasonable opportunity” to earn Medicare-equivalent reimbursement rates, beginning in October of this year. The settlement ends a 10-year-long class action lawsuit between the Florida Academy of Pediatrics, the Florida Academy of Pediatric Dentistry, parents of children enrolled in Medicaid, and the State. The settlement also requires Florida's Agency for Health Care Administration to ensure that Medicaid managed care plans meet certain national benchmarks, such as increasing the percentage of Medicaid-enrolled children receiving preventive medical and dental care. Additionally, the State will be required to resolve specific difficulties with eligibility and enrollment for children, such as improper terminations of eligibility. A federal court will retain jurisdiction of the case through 2022 to ensure the State fulfills the requirements of the settlement, which is being funded out of Medicaid program savings.

Massachusetts: State Negotiates Drug Rebate Program to Expand Access for Hepatitis C Treatment

MassHealth (Medicaid) announced that it successfully negotiated a new drug rebate program with two drug manufacturers for Hepatitis C treatments. The program, which goes into effect in August, is expected to expand treatment options for any Medicaid-enrolled individual who has the virus, while holding the State’s annual treatment costs steady at $200 million. Between December 2013 and January 2016, MassHealth covered Hepatitis C drugs for approximately 4,430 members at a total cost of $318 million.

New Hampshire: Substance Use Disorder Benefits Extended to More Medicaid Enrollees

The State Department of Health and Human Services (DHHS) extended substance use disorder (SUD) benefits that are already covered for the State’s Medicaid expansion population to 140,000 traditional Medicaid enrollees as of July 1, 2016. The more comprehensive set of SUD benefits is available through both fee-for-service and managed care and includes screening services, residential treatment, opioid treatment programs, recovery support services, and recovery monitoring, among others. The expansion of SUD benefits to traditional Medicaid enrollees will also support existing initiatives under the State’s recently-approved DSRIP demonstration, which includes an increase in SUD provider capacity and infrastructure.

Wyoming: Medicaid Reduces Benefits and Provider Rates in Response to Budget Cuts

A $90 million Department of Health (DOH) budget cut for the fiscal year 2017-2018 biennium, announced by Governor Matt Mead (R) last month, went into effect on July 1; DOH will also lose $43 million in federal matching funds. More than half of the State budget cuts ($54 million) come from Medicaid. In response to those cuts, DOH has planned to end dental and vision services for adult Medicaid enrollees, with the exception of emergency services, and to reduce most provider reimbursement rates by 3.3%, among many other cost-saving measures. Governor Mead has argued that if the State had expanded Medicaid, the cuts would not have been as severe.