The State Journal: Recent CMS 1115 Medicaid Waiver is good for West Virginia
As we all know, West Virginia has a drug crisis. The opioid and prescription drug abuse epidemic touches every sector of our state —our health-care system, our first responders, our economy, our judicial and jail system, our social services programs, and our West Virginia families who are on the front line dealing with the devastating consequences. This week, West Virginia took a giant step forward in its ability to provide treatment to those with a substance use disorder who are enrolled in the Medicaid program. With the approval of the 1115 Medicaid waiver by the Centers for Medicare and Medicaid Services (CMS), the West Virginia Department of Health and Human Resources (WV DHHR), Bureau for Medical Services (BMS) can now use Medicaid funds to create innovative and important treatment and recovery services that are not now covered by Medicaid. The waiver will contribute to a comprehensive statewide strategy to combat prescription drug abuse and opioid use disorders. It will allow West Virginia to cover services like methadone, naloxone, peer recovery support, withdrawal management and short-term residential services to all Medicaid enrollees. In short, it will allow West Virginians to decide for ourselves what services are important for our state, and create a pathway to coverage for those services.
Why is this waiver so important to West Virginia? We need a variety of prevention and treatment services to tackle this drug epidemic. Removing payment barriers will allow treatment providers to create prevention, treatment, and relapse prevention services, and let them be reimbursed for those services. Creating a continuum of care beyond what is currently available to Medicaid enrollees will facilitate restorative and supportive services for those in recovery, allowing our recovering citizens to create new pathways to improve their health, reunite with their families, enter an educational program, or re-enter the state’s workforce.
At the Highland Companies in Charleston, we currently offer short-term detoxification programs (at Highland Health Center and outpatient treatment for those with substance use disorder at our Process Strategies location). Where we’ve been limited, as have other psychiatric specialty hospitals in West Virginia and across the country, is in our ability to create innovative drug treatment programs in our hospitals. You see, since the creation of the federal Medicaid program in the 1960s, an outdated restriction has been in place prohibiting free standing psychiatric hospitals from providing care to adults (age 22-64) who are Medicaid enrollees. While many efforts have been made to repeal this portion of the Medicaid rules, the rule still exists. Therefore, in West Virginia, we’ve been severely limited in our creativity with providing services to address the substance use crisis. Adult beds in hospitals go unused because of these restrictions. This outdated federal rule is counterintuitive and counterproductive. Governor Justice, Secretary Crouch of the WV DHHR and Commissioner Beane of BMS should be praised for having recognized this restriction and for success in gaining a waiver of this provision. With the granting of the waiver for West Virginia, doors have been opened to expand substance use services provided by specialty psychiatric hospitals.
Many of our citizens who are experiencing substance use disorder have serious medical problems, along with other mental health problems, which complicate their recovery. Some of these clients begin their care for physical ailments at a medical surgical hospital. Once their medical problems are under control, this waiver will allow us to create innovative programs such as stepdown from a medical surgical hospital after medical problems have been treated to a psychiatric facility for continued mental health and drug treatment programming. We can create short-term acute-care programs for those with mental illness, along with their substance use disorder, and then transition them into short-term residential programs for continued recovery.
In the fight against the drug crisis, we need to use all tools at our disposal. All of our resources need to be focused in the same direction. The 1115 waiver will allow expansion of programs, addition of services, and will start our state on the road to recovery. While much is still left to do, the CMS 1115 waiver is a good start.
Article located at The State Journal.