For generations, the federal government has largely refrained from paying for mental health and substance use treatment in large residential facilities.
That changed in 2015 when, in response to increasing overdose deaths nationwide from illicit drugs, the federal government allowed states to waive a longstanding prohibition against using federal Medicaid funding for services in so-called institutions of mental diseases. In turn, states were required to improve their addiction care with an emphasis on increasing treatment with medications.
Yet a new study by researchers at Oregon Health & Science University finds no overall benefit in terms of increased treatment or decrease in nonfatal overdoses among the 17 states that received those waivers between 2017 and 2019, compared with 18 that did not. Medicaid is a joint federal-state health insurance program that covers about 90 million Americans, although not every state extends Medicaid coverage to all low-income adults.
The study published today in this month’s edition of the journal Health Affairs.
“The waivers have been important to update Medicaid’s program to treat opioid use disorder, however they alone do not appear to have meaningfully improved the situation in terms of uptake of medication to treat opioid use disorders or in reducing overdoses,” said lead author Stephan Lindner, Ph.D., associate professor in the OHSU Center for Health Systems Effectiveness and a faculty member of the OHSU-Portland State University School of Public Health.
Lindner noted that the null result highlights the fact that the waivers may be necessary but are clearly insufficient to bring the nation’s overdose epidemic under control. “These waivers started about 10 years ago,” he said. “Back then, about 50,000 people died of drug overdoses per year. Fast forward 10 years, and more than 100,000 people die of drug overdoses in the United States per year.
“We have made some progress in addressing the opioid crisis, but we need more substantial action at the federal level to make sure all people with opioid use disorder get the treatment they need.”
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