CMS Announces New Medicaid Policy to Combat Opioid Crisis

Just a week after President Trump declared the opioid epidemic a public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment.

Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver, according to a letter CMS sent to state Medicaid directors. Previously, states had been required to build out their entire delivery system for SUD treatment while also meeting rigid CMS standards before Medicaid demonstration approvals could be granted. The new policy will allow states to provide greater treatment options while improving their continuum of care over time.

According to a new study, nearly a quarter of patients on Medicaid filled a prescription for an opioid painkiller in 2015. Express Scripts, one of the largest pharmacy benefits manager of Medicaid drug benefits in the country, analyzed data on 1.8 million opioid prescriptions given to 3.1 million Medicaid enrollees in 14 states. It found that 6 percent of all Medicaid prescriptions were for opioids. Of those that acquired opioids, nearly one-third took the medications for more than 30 days.

Opioids also contributed notably to costs, accounting for 4.1 percent of plan costs overall. Medicaid enrollees are 10 times more likely to be drug addicts or substance abusers than the general population, according to the report.

In the letter, CMS said that state projects under its new program should aim to make notable improvements over the course of five years with goals to increase access, reduce overdose deaths, reduce use of the emergency department or inpatient care for drug addiction treatment and improve care coordination.

CMS also said that it will “ensure states take significant steps” to reduce opioid prescribing.