Trump Administration Approves Two New State Medicaid Demonstrations to Treat Substance Use Disorders and Combat National Opioid Epidemic

The Centers for Medicare and Medicaid Services (CMS) announced today that Minnesota and Nebraska have become the 23rd and 24th states who have received approval under the Trump Administration for innovative demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD).

Under the section 1115 demonstrations, Minnesota and Nebraska are approved to receive Medicaid matching funds for treatment in facilities that meet the definition of an institution for mental diseases (IMD). Since announcing a more flexible approach to these demonstrations through a November 2017 Medicaid policy announcement, the Trump Administration has accelerated efforts to help states combat the national opioid epidemic, decreasing overuse and saving lives.

 “The Trump administration is committed to offering a more flexible, streamlined approach to accelerate states’ ability to expand addiction treatment services during this national crisis,” said CMS Administrator Seema Verma, “Whereas only a handful of states were approved for these demonstrations before 2017, our approach has allowed us to approve nearly 20 more demonstrations in just 18 months.”

Under the Minnesota demonstration, Medicaid eligible individuals will receive enhanced mental health services through Minnesota’s Certified Community Behavioral Health Clinics (CCBHCs). Temporary expenditure authority will allow CCBHCs to integrate community health care providers to increase rates of identification, initiation, and engagement in treatment for SUD.

CMS expects the Nebraska demonstration will enhance existing substance abuse related services and offer those services to beneficiaries in more appropriate treatment locations, including residential facilities.  As a result the anticipated outcome is that more patients will receive a more complete array of required treatments than before the demonstration.

States will monitor and report the impact of changes to address SUD and OUD over the course of the demonstrations. States who have already implemented their programs are beginning to report positive results. For example, Virginia experienced a 4 percent decrease in acute inpatient SUD admissions during the first 10 months of implementation, along with a 6 percent decrease in opioid use disorder inpatient admissions. During the first year, the total number of prescriptions for opioid pain medications among Medicaid beneficiaries decreased by 27 percent while the number of prescriptions for non-opioid pain relievers remained unchanged. In one year of early implementation of the Maryland demonstration, over 8,000 Medicaid beneficiaries received residential treatment services.

Expanding access to treatment for people with opioid use disorder (OUD) is one key strategy identified in CMS’s Roadmap to Address the Opioid Epidemic, which details agency efforts in combatting the opioid crisis. More than two million people suffer from OUD, yet only 20 percent of people with OUD receive treatment. These demonstrations will allow Minnesota and Nebraska to improve access to high quality, clinically appropriate treatment for OUD and other SUDs, in ways that take into account the particular challenges the opioid epidemic has caused in their respective states. Both demonstrations are approved for a five year period beginning on July 1, 2019, and ending on June 30, 2024.

For More information regarding the Minnesota and Nebraska, demonstrations please visit:
Minnesota: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/mn/mn-sud-reform-ca.pdf

Nebraska: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ne/ne-sud-demo-ca.pdf

States with previously approved demonstration approvals include Illinois, New Jersey, Louisiana, Indiana, Kentucky, Utah, Vermont, Pennsylvania, New Hampshire, Washington, North Carolina, Wisconsin, Alaska, New Mexico, Kansas, Rhode Island, Michigan, Massachusetts, Maryland, Virginia, California and West Virginia.

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