New Medicaid initiative improves access to substance use disorder treatment

Byline: Vikki Wachino

The Medicaid program plays an important role in providing access to treatment for individuals with a substance use disorder (SUD). Nearly 21 million Americans suffer from SUD, many of whom are low-income or uninsured. It is estimated that 12 percent of all Medicaid beneficiaries ages 18-64 and 15 percent of uninsured individuals who could be eligible for Medicaid coverage have SUD. Medicaid pays one out of every five dollars for SUD treatment.

As states identify new ways to promote stronger systems of care that improve access to affordable quality health care, strengthening approaches to SUD services is a major area of focus. Many states are seeking to reform SUD treatment services in a way that meets the needs of individuals as well as the capacity for treatment in their states.

The Centers for Medicare & Medicaid Services (CMS) is working with states to develop system reforms that improve care, enhance treatment, and offer recovery supports for individuals with SUD. For the past year, CMS has worked with states through our new Medicaid Innovation Accelerator Program to provide program support for states to pursue innovations that reduce costs and improve health outcomes for beneficiaries with SUD. We have also been in active dialogue with states on ways to combat the opioid and heroin epidemic that is ravaging many rural and urban communities alike.

Building upon this effort, CMS is now launching a new demonstration initiative to support comprehensive, evidence based service delivery approaches to SUD treatment. This initiative is available to states seeking to undertake significant improvements in the delivery of care to beneficiaries with SUD, such as better identifying individuals with SUD, increasing treatment provider capacity, using evidence-based practice standards, and measuring progress with quality metrics.

The initiative provides greater flexibility for states that undertake significant reforms to provide coverage for short-term inpatient and residential SUD services – services generally not covered by Medicaid. These improvements will help states develop effective care coordination models that better connect those with SUD to providers, provide more integrated health care services to beneficiaries with SUD, and effectively integrate SUD treatment with community-based care.  

We recognize the importance of effective SUD treatment and remain committed to working with states and stakeholders to improve SUD services for millions of individuals.

For more information on the demonstration initiative, visit http://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf.

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