With support from: A grantee of the Robert Wood Johnson Foundation Medicaid’s Critical Role in Addressing the Opioid Crisis April Grady Manatt Health Strategies June 25, 2018 AcademyHealth Annual Research Meeting
2 About State Health & Value Strategies State Health and Value Strategies (SHVS) assists states in their efforts to transform health and health care by providing targeted technical assistance to state officials and agencies. The program is a grantee of the Robert Wood Johnson Foundation, led by staff at Princeton University’s Woodrow Wilson School of Public and International Affairs. The program connects states with experts and peers to undertake health care transformation initiatives. By engaging state officials, the program provides lessons learned, highlights successful strategies, and brings together states with experts in the field. Learn more at www.shvs.org. About Manatt Health Manatt Health integrates legal and consulting expertise to better serve the complex needs of clients across the healthcare system. Combining legal excellence, first-hand experience in shaping public policy, sophisticated strategy insight, and deep analytic capabilities, we provide uniquely valuable professional services to the full range of health industry players. Our diverse team of more than 160 attorneys and consultants from Manatt, Phelps & Phillips, LLP and its consulting subsidiary, Manatt Health Strategies, LLC, is passionate about helping our clients advance their business interests, fulfill their missions, and lead healthcare into the future. For more information, visit https://www.manatt.com/Health.
Objectives 3 Provide data on Medicaid’s role in addressing the opioid epidemic Review Medicaid tools available with regard to: – Expanding coverage of substance use disorder (SUD) treatment services – Increasing treatment capacity – Addressing prescriber behavior For additional information, see A. Grady, P. Boozang, D. Bachrach, A. Striar, and K. McAvey, Medicaid: The Linchpin in State Strategies to Prevent and Address Opioid Use Disorders , State Health & Value Strategies Issue Brief (Mar. 16, 2017), https://www.shvs.org/resource/medicaid- the-linchpin-in-state-strategies-to-prevent-and-address-opioid-use-disorder/.
4 Data on Medicaid’s Role in Addressing the Opioid Epidemic
Medicaid is a Major Source of Treatment Dollars for People with Opioid and Other Substance Use Disorders 5 Medicaid covers nearly 40% of adults more on services for people with an opioid use disorder (OUD) Medicaid with an OUD prior to expansion ($9.4B) than the spent 3x Medicaid spending on comprehensive entire SAMHSA budget for SUD ($2.9B) health care services for people with an OUD is substantially higher than all other federal funding opioid overdose deaths in the 42,000 Medicaid is addressing OUD along with United States in 2016 a multitude of co-occurring conditions that, if left untreated, perpetuate the cycle of addiction of Medicaid spending for individuals with OUD is for Opioid use disorder is only one of many >50% physical and behavioral health issues that co-occur with substance use disorders that states substance use disorders must address
Medicaid Spending For Medication-Assisted Treatment (MAT) Has Grown Rapidly 6 MAT pairs medication with psychosocial therapies for people with OUDs Medicaid Spending on Buprenorphine, Naltrexone, and Naloxone Medicaid covers a range of SUD Prescriptions for OUD, by State Expansion Status (in millions) treatment services , such as inpatient detoxification, intensive outpatient, care coordination, and MAT Most Medicaid spending for OUD prescriptions is on buprenorphine – In 2016, Medicaid paid for 24% of buprenorphine prescriptions; nearly double that amount in some states – In Ohio, nearly 50% of buprenorphine prescriptions were paid by Medicaid Medicaid spending on MAT drugs has more than doubled over the past five years, to nearly $1 billion in 2016 Growth rates have been highest in states that expanded Medicaid
State-Level Data Illustrate the Key Role of Medicaid in Addressing OUD 7 Data from high-impact states indicate that spending on Medicaid SUD treatment alone for people with an OUD was 6 to 12 times the amount of non-Medicaid federal grant funds available to address the opioid epidemic in 2017 Ohio New Hampshire West Virginia New Hampshire spent $80 Among West Virginia’s In Ohio, a recent study found million on Medicaid services Medicaid enrollees with an that expansion adults with for enrollees with OUD in 2017, OUD, 75% of Medicaid substance use disorders were compared to $5.2 million in spending in 2017 ($254 million more likely to report opioid-specific federal grants out of $339 million) was for improvement in overall access from sources other than physical and behavioral health to care than those without, and Medicaid services other than direct those improvements were treatment of addiction even more evident for the subgroup of enrollees with an OUD
Expansion Adults Account For a Large Share of Medicaid Enrollees in Need of OUD and Other SUD Treatment 8 Medicaid eligibility changes that limit or restrict expansion adult coverage would have a significant impact on funding of SUD treatment services
Even Prior to Expansion, Medicaid OUD Spending Was Substantial 9 In 2013, Medicaid spent $9.4B in federal and state dollars on comprehensive health care services for 636,000 individuals with an OUD Medicaid Spending for People with an OUD Compared to The largest sources of non- Non-Medicaid Federal Grants to States for Medicaid OUD funding in 2017 OUD/SUD Treatment and Prevention (in millions) included: – $500M : Opioid State Targeted Response to the Opioid Crisis (SAMHSA) – $40.8M : Prevention for States Program (CDC) – $12M : First Responders (SAMHSA) – $4.2M : Pain Management Collaboratory (NIH) – $25M : Targeted Capacity Expansion MAT–Prescription Drug and Opioid Addiction (SAMHSA)
OUD Funding Sources Outside of Medicaid Are Growing But Still Limited 10 FY 2018 omnibus appropriations bill enacted in March allocates $3.3 billion of funding for 2018 to combat the opioid epidemic Builds on the 21 st Century Cures Act that funded the previously- authorized $500 million per year for 2017 and 2018 in state grants The $3.3 billion in funding includes: – $1.4 billion to SAMHSA for state grant programs – $500 million to the NIH for addiction research – $415 million for the Health Resources and Services Administration to improve access to addiction treatment in rural communities – $350 million to the CDC for opioid overdose prevention, surveillance, and state prescription drug monitoring programs – $500 million to the VA for mental health programs
Congress and the Administration Are Continuing Efforts to Address the Opioid Crisis 11 Congressional action as of early June – House passed the first of several opioid-related legislative packages that are expected to come to the floor in coming weeks – Within the House and Senate, debate continues regarding Medicare and Medicaid legislative provisions designed to address the epidemic – Less controversial provisions include reducing opioid use for pain management, educational efforts, and measures intended to expand SUD treatment provider supply – More heavily debated issues include the Medicaid IMD exclusion and data-sharing/privacy Recent Centers for Medicare & Medicaid Services (CMS) actions – CMS Roadmap to Address the Opioid Epidemic provides an overview of CMS actions to date and future areas of focus – State Medicaid Director Letter provides guidance to states on funding authorities that may support health information technology efforts to address the epidemic – Informational bulletin for states regarding Medicaid coverage and developing effective strategies for the treatment of infants with Neonatal Abstinence Syndrome (NAS)
12 Examples of Tools Available to Medicaid in Addressing the Opioid Epidemic
Medicaid Programs Are Employing a Range of Strategies to Tackle the Opioid Epidemic 13 Expanding Access to Treatment • Conduct systematic review of existing SUD benefits to identify and address any gaps around payment, services covered, and utilization management strategies • Expand intensive care management services, including care plan development, patient navigation services, and outreach & enrollment into treatment • Design special plans for individuals with mental illness and SUD • Enhance provider and workforce education on evidence-based treatment for OUD Increasing Capacity to Treat • Enhance payment rates for providers meeting best practices in SUD prevention and treatment • Require health plans to contract with certain providers, pay providers more for high-priority services, and provide incentives to plans that meet certain metrics Addressing Opioid Prescribing Behavior • Increase Medicaid’s access to states’ Prescription Drug Monitoring Programs • Require prior authorization for opioids; institute quantity and renewal limits • Strengthen utilization review criteria • Promote use of MAT, and add naloxone to preferred drug lists
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