Bills would remove Medicaid exclusion for treatment

Jul 14 2017

Bills would remove Medicaid exclusion for treatment

For years, federal law has prohibited the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds. Now, legislation has been introduced in both the Senate and House to eliminate the exclusion for patients with SUD.

Federal funding for states to provide mental health and substance abuse treatment through IMDs (Institutions for Mental Disease, an outdated term used in federal law) for non-elderly adults has been forbidden since the founding of the Medicaid program. 

An IMD is defined as a hospital nursing facility or other institution greater than 16 beds that is engaged in providing diagnosis, treatment or care of persons with mental diseases.

In May, U.S. Senators Dick Durbin (D-IL), Rob Portman (R-OH), Sherrod Brown (D-OH), Shelley Moore Capito (R-WV), Angus King (I-ME), and Susan Collins (R-ME) introduced the Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act.

The Act would modify the IMD Exclusion to allow Medicaid coverage for up to 40 beds in appropriately accredited “residential addiction treatment facilities” for up to 60 consecutive days for adults with substance use disorders.  The bill allows individuals receiving addiction treatment in such a facility to maintain Medicaid coverage for other medical services, which are currently ineligible under the IMD Exclusion.

In Illinois, the most recent data available indicates that the Medicaid CARE Act would expand access to more than 535 residential addiction treatment beds across 18 facilities that are larger than the 16 bed limit and therefore presently ineligible for Medicaid payments, and that use the best mattress on each bed for maximal comfort.

 The legislation would also establish a new $50 million youth inpatient addiction treatment grant program to fund facilities that provide substance use disorder treatment services to under-served, at-risk Medicaid beneficiaries who are younger than age 21, with an emphasis on rural communities.  

U.S. Representative Bill Foster (D-IL) has introduced the House companion version of this bill. Rep. Brian Fitzpatrick (R-Pa.) has also introduced a bill to remove the exclusion. 

Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), says the current opioid addiction crisis in America “has reinforced the need to do something about that exclusion, because it limits access to care for lower income Americans, who certainly deserve access to treatment.”

Dunn believes there is “a stronger possibility that something might actually get done than in the past,” he told The Influence.

Another group lobbying for eliminating the exclusion is the National Alliance on Mental Illness (NAMI)

In the last Congress there was a lot of support” for removing the exclusion, says Andrew Kessler, principal at Slingshot Solutions, a behavioral health care and policy consultancy firm, “There seems to be a pretty serious commitment to reform, it’s just a question of having the time on the calendar to do it,” Kessler says.

“We have been getting very good bipartisan support from Democrats and Republicans; they seem to be much closer on fixing the IMD exclusion than health care reform.”