White House commission on drug abuse recommends increasing Medicaid spending

The recommendation comes on the heels of an aggressive push to reduce funding.

This June 2017 photo shows discarded used hypodermic needles at an encampment where opioid addicts shoot up along the Merrimack River in Lowell, MA. CREDIT: AP Photo/Charles Krupa
This June 2017 photo shows discarded used hypodermic needles at an encampment where opioid addicts shoot up along the Merrimack River in Lowell, MA. CREDIT: AP Photo/Charles Krupa

The President’s Commission on Combating Drug Addiction and the Opioid Crisis, established by President Donald Trump in March in response to a nationwide epidemic, publicly released their interim recommendations on Monday.

The commission, which is chaired by New Jersey Gov. Chris Christie (R), said the best way to “rapidly increase treatment capacity” is to expand the availability of treatment under Medicaid with more federal funds. The commission, which also includes the governors of Massachusetts and North Carolina, calls expanding the availability of Medicaid “the single fastest way to increase treatment availability across the nation.”

The recommendation, the very first one offered by the commission, comes on the heels of a prolonged effort by the Trump administration and the White House to shrink Medicaid as part of the repeal of Obamacare. The Republican health care bill that passed the House of Representatives, and was celebrated by Trump, would have not only rolled back Medicaid expansion under Obamacare but also dramatically cut federal funds for those remaining in the program. In total, the legislation would have cut Medicaid by over $700 billion.

The Medicaid cuts were anathema to several Republican Senators concerned about the impact of opioid crisis in their states. So Majority Leader Mitch McConnell (R-KY) eventually added $45 billion over 10 years to help offset the impact. That amount was insufficient to offset the impact of the Medicaid cuts, however, according to experts.

In several states, including Ohio, Kentucky, and West Virginia, Medicaid already pays for more than 40 percent of addiction treatment medications. In Pennsylvania last year, “Medicaid expansion helped 124,000 people get treatment for their substance use disorder.”

The president’s commission recommended expanding the availability of treatment under Medicaid by waiving rules that prohibit “federal Medicaid funds from reimbursing services provided in an inpatient facility treating ‘mental diseases’ that have more than 16 beds.”

Currently, states are responsible for the full costs of such treatment, limiting its availability, Emma Sandoe, a former CMS Medicaid spokesperson, told ThinkProgress.

“These places have historically been funded by states so the exclusion was put in place to prevent states from shifting funds between programs. Instead these places have largely been underfunded as states have moved away from their role of funding mental disease,” Sandoe said. “This proposal would allow federal Medicaid money for these services, which could at least temporarily increase Medicaid spending as we treat and fight the opioid epidemic.”

The commission is proposing a waiver of the restriction as part of the President’s declaration of a state of emergency. A full repeal was estimated to cost $40 to $60 billion, according to Sandoe, who is now a health researcher and PhD candidate at Harvard.

In other words, the commission is recommending a significant increase in Medicaid spending as the most effective way to expand addiction treatment.

Notably, the interim recommendations do not mention building a border wall or more aggressive criminal enforcement, two policies advocated by Trump and Attorney General Jeff Sessions.