Medicaid considering expanded drug addiction coverage

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With the surge of heroin addiction and prescription drug abuse in recent years, the lack of coverage for addiction treatment has become a growing concern.

Now, the group governing the federal Medicaid program is proposing to cover 15 days of inpatient rehab per month for people enrolled in any of their plans. It’s a stark and meaningful shift in agenda for people with drug addictions who previously had to rely on state and local sources to be treated, according to a WITF/ NPR story.

Still, experts in the field and former addicts have divided views about the proposed policy.

Most agree that 15 days isn’t enough time, although an absence of research and data about inpatient treatment means that private plans vary in length as well.

Successful therapy is based on adequate treatment length, according to the National Institute on Drug Abuse. If the 15 days don’t produce results, it could be a waste of taxpayer dollars, one expert told NPR.

It could also be an easily exploited program.

Cindy Mann, a former top administrator at the federal Centers for Medicare and Medicaid Services, told NPR that it’s a “good start” because Medicaid hasn’t funded any residential treatment programs.

From the article:

"Maybe it's half a loaf for someone who needs 30 days," says Mann, who now works for Manatt Health Solutions, a law and consulting firm. "But it's half a loaf of new federal dollars that could be available."

A former addict interviewed by NPR said it took five months of inpatient treatment to break a heroin habit.

As an alternative, the article reports that outpatient treatment programs can be more effective and less expensive for some people.

In Pennsylvania, a provision exists that allows for “federal reimbursement for much longer rehab stays for some people,” according to the article. The changes might eliminate the loophole.

Although there are concerns about the limitations of the proposed policy, Mann noted to NPR that states still have the ability to pay for as much treatment they think a patient needs.

From the article:

"The state and the locals are completely free to finance that stay if they think it's the right place for somebody to be," she says.

And if they're still not happy, she adds, states can put together innovative treatment programs to apply for more federal money.

PublicSource previously reported on how little state money actually goes to drug treatment programs, as well as the inaccuracy of heroin overdose statistics that can affect how health resources are applied.

Reach Stephanie Roman at sroman@publicsource.org. Follow her on Twitter @ShogunSteph.