Since 2017, the federal government has awarded $2 billion to states specifically for opioid prevention, treatment, and recovery. But a new spending package passed last month allows states to use federal funds to address the growing use of stimulants, including cocaine and methamphetamine, that are emerging as the newest wave of drugs fueling the overdose crisis in many states.
The opioid epidemic has heightened states’ efforts to prevent and treat of substance use disorder (SUD) in pregnant and parenting women. The National Academy for State Health Policy (NASHP), with support from the Health Resources and Services Administration, interviewed Colorado, Pennsylvania, and Texas officials about the unique interagency approaches they are using to promote recovery for this population. This new report explores:
- State coverage, care delivery, and financing strategies to support pregnant and parenting women with SUD;
- Available state and federal funding sources for these initiatives; and
- Key considerations for states working to promote recovery.
- Download webinar slides and listen to the webinar that explored how Colorado supports pregnant and parenting women with SUD. The speakers were:
- Amy Cooper, Women’s Services Coordinator, Office of Behavioral Health, Colorado Department of Human Services;
- Susanna Snyder, Maternal Child Health Policy Specialist, Health Programs Office, Colorado Department of Health Care Policy and Financing; and
- Dr. Kaylin Klie, Physician, Denver Health; Assistant Professor, University of Colorado Department of Family Medicine
- Read NASHP’s issue brief State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis, and listen to a NASHP webinar on the topic.
- Read presentations from NASHP’s preconference Turning the Tide: State Strategies to Meet the Needs of Families Affected by Substance Use Disorder.
Last week, Congress sent the SUPPORT for Patients and Communities Act, a wide-ranging bill that seeks to address the country’s opioid crisis across a number of policy areas, to the President for his signature. The act contains numerous provisions that affect how state Medicaid agencies structure and administer services and supports for individuals with opioid and other substance use disorders (SUD).
Medication-assisted treatment (MAT) emerges as a central strategy, and the act gives states some flexibility to expand SUD service delivery using Institutes for Mental Disease (IMDs). A number of provisions also address the impact of SUD on pregnant women, infants, children, and youth. The table below highlights some of the act’s key provisions affecting state Medicaid programs.
|Requires states to cover children in foster care up to age 26 and to suspend eligibility for juvenile justice-involved youth (Sec. 1001, 1002)||By calendar year 2023, states must provide former foster care youth with Medicaid coverage up to age 26, regardless of what state they lived in when they aged out of the foster care system. Currently, Medicaid must cover youth up to age 26 within the state the youth aged out of foster care, and states have the option to cover youth who age out of another state’s foster care system. For youth engaged in the criminal justice system, the act requires states to suspend, rather than terminate, Medicaid coverage while these youth are incarcerated, and to restore their Medicaid coverage upon their release, without completing a new application, unless they no longer meet eligibility requirements.|
|Creates a demonstration program to expand SUD treatment
|The act creates a new demonstration program to improve capacity for SUD treatment services, with a particular focus on MAT, neonatal abstinence disorder, pregnant and post-partum women, and adolescents. Ten states will receive planning grants, and of those states, five will be selected to receive enhanced federal match for SUD treatment and recovery services.|
|Additional requirements for Medicaid drug utilization review
|By October, 2019, states will be required to have safety edits and automated review processes in place to avoid prescription abuse, monitor and report on antipsychotic medication prescribing to children, and identify fraud and abuse by Medicaid enrollees, providers, and pharmacies.|
|Extends SUD health home enhanced match to 10 quarters
|For health home state plan amendments approved on or after Oct. 1, 2018, the act extends enhanced Federal Medical Assistance Percentages (FMAP) funding to states from eight quarters to ten.|
|Requires MAT to be included in state plans
|From Oct. 1, 2020 to Sept. 30, 2025, states will be required to include MAT services in their state plans. States may certify that implementing the provision is not feasible due to a shortage of qualified providers or facilities to provide MAT.|
|Changes in Institutions for Mental Disease coverage
(Sections 1012, 1013, 5052)
|Clarifies payment for treatment at residential pediatric recovery centers
|Permits states to pay for inpatient or outpatient services, including counseling for parents, at residential pediatric recovery centers that treat infants with neonatal abstinence syndrome.|
|Strengthens prescription drug monitoring programs
|Starting October 2021 , states must require Medicaid providers to check patients’ prescription drug history before prescribing controlled substances. The act allows for enhanced FMAP to states for expenditures to design, develop, or implement a prescription drug monitoring program that meet the act’s requirements.|
|Changes Medicaid managed care medical loss ratio
|Permits states to receive an enhanced share of remittances from Medicaid managed care plans that do not meet the minimum medical loss ratio of 85 percent.|
|Mandates reporting on adult behavioral health measures
|Beginning with the state report for 2024, states will be required to report on all behavioral health measures included in the adult core measure set.|
|Extends mental health parity to Children’s Health Insurance Programs (CHIP)||Requires all state CHIP programs to include coverage of mental health services, including behavioral health treatment. The provision explicitly notes that the requirement for these comprehensive services applies to both children and pregnant women regardless of the type of coverage (including separate CHIP programs) that a state has selected to operate.|
NASHP congratulates the five states selected to participate in NASHP’s State Substance Use Disorder (SUD) Policy Institute:
- South Dakota
The State SUD Policy Institute, supported by a cooperative agreement with the Health Resources and Services Administration, will assist these five state teams to develop innovative strategies to increase access to and improve the quality of SUD treatment, recovery, and preventive services for Medicaid beneficiaries using federally qualified health centers (FQHCs). The institute began in September 2018.
What’s in it for states?
- Eighteen months of flexible, practical support and resources, including:
- Individualized assessments of states’ policies and regulatory barriers;
- Assistance developing a state action plan;
- State-specific supports and resources; and
- Opportunities to connect with peers and state, federal, and national experts while supported by NASHP’s in-house expertise.
Team composition: Each state team consists of a senior Medicaid official, a senior state behavioral health agency or division official; a senior representative from the state’s primary care association, and one FQHC representative. Additional team members may be included as needed.
More information: Interested states and partners can view an informational webinar, held July 12, 2018, that provided more information about the institute. To download the slides, click here. To view the webinar, click here. Email questions to Hannah Dorr (firstname.lastname@example.org).
Archived RFA and Application Questions
View or download the Request for Applications.
Download the Application Questions.
View frequently-asked-questions about the institute.
The institute is supported through the National Academy for State Health Policy’s National Organizations for State and Local Officials Cooperative Agreement with the Health Resources and Services Administration.
PORTLAND, OR – State health officials shared wide-ranging innovations in their uphill battle against the opioid epidemic that is sweeping their states at the opening day of the National Academy for State Health Policy’s (NASHP) 30th State Health Policy Conference.
Officials explained they are experimenting with new strategies that use data, new treatment approaches, and reconfigured public safety responses to illegal drug use in a race against time as overdose deaths are expected to exceed the 63,000 recorded in 2016.
Kimberly Johnson, MD, director of the US Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment, ticked off the various strategies and services that are being tried out in state incubator programs that show promise in tackling this national epidemic, including providing treatment on demand, decriminalizing illegal opioid use, creating safe drug use sites and needle exchange programs, improving diagnosis of people with opioid addiction, better use of data to identify drug use patterns in communities, and addiction treatment with medications, such as methadone, which is proven to lower relapse rates.
“The number one thing states can do,” she commented following her opening remarks Monday morning, “is to address prescribing practices among providers. But it really takes all of these strategies to stop this epidemic.”
While NASHP’s three-day conference addressed a host of state public health issues, the nation’s opioid epidemic was a frequent topic at various workshops. It remains the Achilles heel, officials noted, that exposes states’ conflicting and piecemeal public health approaches even while providing opportunities for innovation.
Ana Novais, executive director of Rhode Island’s Department of Health, highlighted her state’s effort to create a dashboard that pulls data from hospitals, police, emergency rescue workers, and providers to create an overdose reporting system. Armed with data, including the latest on fentanyl deaths and locations of overdoses, the state can launch responses that involve police, rescue workers, health care providers and community leaders.
In Ohio – where one in nine of the nation’s heroin overdoses occur — the Office of Health Transformation, led by director Greg Moody, is tackling opioid over-prescribing through a health care reform called value-based pricing that rewards Medicaid managed care providers who provide high-quality care at reasonable prices.
“We wanted to knit together strategies from different domains within state government to address the opioid crisis,” he explained to more than 200 officials who attended the session. To prevent future addictions, Ohio has spearheaded a payment innovation approach to discourage over-prescribing of opioids and reward “best-practice” painkiller prescribing in its Medicaid managed care program.
One of the quality measures Ohio uses to identify “high-value” health care providers is their opioid prescribing practice. The state examines how many opioids a provider – including dentists and orthopedic specialists — prescribe and for how long. Their prescribing practices are compared with the state average. Providers who prescribe above the average amount and duration of painkillers may not get referrals and may eventually lose financial incentives.
Pennsylvania’s approach to prevent future addictions is to provide Medicaid coverage for alternative pain management treatment, such as acupuncture and yoga.
Increasing access to medically-assisted treatment for addiction, educating providers to improve opioid prescribing practices, and building coalitions between public safety and communities to get people into treatment is daunting, officials noted. Some states are proposing to add a work requirement to their Medicaid programs, similar to what exists for adults receiving Temporary Assistance to Needy Families (TANF), which concerned some policymakers. “We want to make sure that if people are working toward recovery that they are not excluded from Medicaid eligibility,” one attendee pointed out.
Another official pointed out that lawmakers in her state wondered how much funding to invest in the naloxone program if emergency personnel keep reviving the same people after multiple overdoses.
“This is a disease,” said David Kelley, MD, chief medical officer of Pennsylvania’s Department of Human Services Office of Medical Assistance Programs, “does an emergency medical technician say, ‘you’ve had angina five times already, we won’t treat you this time?’ Addiction is a disease, we need to stop thinking how many times is enough.”
“We do have to deal with the political ramifications that people still think of addiction as a personal choice,” observed Mary McIntyre, MD, chief medical officer of Alabama’s Department of Public Health.
NASHP will be publishing many of the “State Innovations and Interventions in America’s Opioid Crisis” presentations and slides, and additional blogs in the weeks ahead at nashp.org.