In an address given from the White House on October 26th, President Trump announced that his administration would be designating the ever growing opioid crisis in America as a Public Health Emergency. By making this designation, the administration has made it possible to waive some regulations and provide more flexible options for states to fight the opioid epidemic with federal funding. On November 1st the Centers for Medicare and Medicaid Services (CMS) issued a letter to all state Medicaid directors outlining a new initiative to streamline the process for creating and implementing treatment demonstrations specifically designed to combat Opioid Use Disorder (OUD) and its associated effects.
The Need for a Public Health Emergency
In the last two decades, OUD cases have increased at an unprecedented rate and both the personal and public costs have been enormously high. Since 1999, overdose deaths associated with the opioid class of drugs have increased by over 2.5 times; claiming over 64,000 lives in 2016. Even beyond the risk of death, OUD can have a significant negative impact on family relations, employment opportunities, and the short and long-term health of the individual.
While OUD cases have continued to increase, the efforts to combat the crisis have been hindered by a lack of high quality and clinically appropriate treatment resources. Medicaid beneficiaries make up nearly one quarter of all adults who suffer from OUD, but in 2015 only one out of three of those individuals received any type of substance abuse treatment.
Providing appropriate and effective treatment for OUD can be beneficial to both the patient and to the Medicaid program costs. Patients with OUD often suffer from additional chronic illnesses, which may be the result of substance abuse or may be independent of it. Either way, in many cases the majority of the costs associated with the medical treatment for individuals with OUD is actually from treating additional conditions and not the disorder itself. However, some research has shown the total costs associated with treating individuals with OUD may go down when those individuals receive appropriate substance abuse treatment.
New Options to Fight the Crisis
The CMS initiative incorporates several strategies to address the ongoing opioid epidemic. The first strategy is to streamline and simplify the administrative process required before being approved for a Medicaid waiver for OUD specific demonstrations. By speeding up the approval process, the states can have their programs up and running quickly in order to provide these critical resources for vulnerable populations. The streamlined process, and more flexible options serve to encourage states that may have otherwise been hesitant to create their own demonstration to develop a plan that addresses the unique needs of their communities.
A second strategy, as outlined in the CMS letters, is to develop a continuously growing repository of best practices. Once a new waiver for a demonstration is approved, the participating states will be required to go through a detailed review and evaluation process in order to determine the success of their programs. These evaluations will then be made available on medicaid.gov for other states to reference as they design or revise their own programs. By creating an easily accessible resource of lessons learned, states can work together towards identifying the most successful strategies to address OUD and benefit those who are affected by it.
Two Programs Already Approved
In addition to issuing the letter, CMS has announced the approval of the first two Medicaid waivers under the new initiative. Utah, which actually started their approval process in July of 2016, has been approved to expand their Medicaid coverage to include up to six thousand childless adults who are either experiencing homelessness, currently in the criminal justice system or in need of substance abuse treatment. The goal of this expansion is to provide both mental health and substance abuse resources for these vulnerable populations. New Jersey was also approved for a waiver in order to expand their Medicaid funding to provide Substance Abuse Disorder (SUD) treatments for thousands more individuals. Their expanded program will focus on strategies such as residential withdrawal management treatment, medication-assisted treatment, peer supports, and targeted case management.
The opioid epidemic is an ongoing emergency that is taking lives and harming communities across the country. As the new CMS initiative encourages new program creation by allowing for more flexibility and simpler approval processes, we expect to see a variety of different ways of providing quality treatment options to the individuals who need it most. The lessons learned from these unique programs can then form a solid foundation as we develop successful long-term strategies to end this tragic epidemic.