How Medicaid Programs Can Help End the Opioid Epidemic
medication-assisted treatment [MAT] helps people stay in recovery longer and saves lives.” The new, provisional figures from the CDC “yet again underscore that this epidemic will not be reversed until we deal with access issues and stigma associated with opioid misuse,” Dr. Harris added. The AMA has urged all health insurance companies and other payers to remove administrative and other barriers to high-quality, evidence-based treatment for patients with pain and those with opioid use disorder. Improving Medicaid OUD treatment is essential to turning the tide. Medicaid expansion under the Affordable Care Act, which requires at least some OUD provisions, and helped add many thousands of OUD patients to gain coverage for their treatment. Adequately serving Medicaid OUD patients requires a multipronged approach, but the common thread among solutions from the AMA and the states leading the way is to increase access to high quality, evidence-based care. Proven MAT therapies like buprenorphine, methadone and extended-release naltrexone, with appropriate cognitive behavioral and mental health support should be included in all public and private insurance plans—without prior authorization or other administrative barriers to treatment. State-by-state levels of MAT coverage and statewide access to trained doctors varies greatly. Another fundamental requirement is much greater access to inpatient OUD care, which federal policy has blocked through Medicaid’s so-called 16-bed IMD limit. The provision—for the anachronistically named “Institutions for Mental Disease”—bans payment at facilities with more 16 psychiatric beds. “Given that only about 10 percent of the nearly 2 million patients with a substance-use disorder can access treatment, it is essential that treatment capacity be increased as expeditiously as possible,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a Feb. 16 letter to leaders of a Senate committee investigating the opioid epidemic. “Removing the 16-bed IMD exclusion is an important first step to increasing physicians’ ability to care for patients with an opioid use disorder.” Among other essential policy changes, the AMA has called for Washington to remove its ban on Medicaid coverage for incarcerated individuals. Inmates with OUD are at high risk for fatal overdose upon release.