WASHINGTON, D.C. – U.S. Senators Shelley Moore Capito (R-W.Va.), Dick Durbin (D-Ill.), Rob Portman (R-Ohio), Sherrod Brown (D-Ohio), Angus King (I-Maine) and Susan Collins (R-Maine) today introduced the Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act, which would expand access to substance abuse treatment for tens of thousands of Medicaid beneficiaries across the country. The Medicaid CARE Act would increase addiction treatment services to help combat the heroin and prescription opioid epidemic by modifying the Medicaid Institutions for Mental Disease (IMD) Exclusion – an arcane policy created in 1965 that limits Medicaid coverage for substance abuse treatment to facilities with less than 16 beds. The Medicaid CARE Act would lift this outdated barrier by expanding Medicaid coverage to pay for up to 40 treatment beds at larger substance abuse treatment facilities.
“West Virginia has been hit hard by the opioid epidemic. It’s a crisis that affects families and communities across our state, and we need to make sure all West Virginians have access to critical treatment and rehabilitation resources,” Senator Capito said. “The Medicaid CARE Act will help ensure individuals struggling with addiction have the care they need to fight and overcome it.”
The IMD Exclusion prohibits the use of federal Medicaid funding for any care provided to patients 22-64 years old in residential mental health or substance abuse facilities larger than 16 beds. This policy was created over 50 years ago to discourage the mass warehousing of those with mental illness. But as understanding and treatment options for addiction have improved, this outdated rule continues to pose a barrier. It also violates substance use disorder treatment parity requirements by unfairly discriminating against Medicaid beneficiaries. This policy is no longer justified, and stakeholders, such as the Surgeon General and National Governors Association, agree that this policy poses a burden to care.
The Medicaid CARE Act modifies 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.
The legislation also establishes a new $50 million youth inpatient addiction treatment grant program to fund facilities that provide substance use disorder treatment services to underserved, at-risk Medicaid beneficiaries who are younger than age 21, with an emphasis on rural communities. In addition, the bill would increase flexibility for pregnant and postpartum women who are seeking treatment, and would allow them to access the services they need to ensure positive birth outcomes. This legislation builds off a letter that Sens. Capito, Durbin, Collins, King, Portman, Brown and 23 other bipartisan senators sent in August 2016 to the Centers for Medicare and Medicaid Services (CMS) pushing for greater flexibility on IMD Exclusion to expand access to treatment.
U.S. Representative Bill Foster (D-Ill.) will be introducing the House companion version of this bill. It is endorsed by the National Council for Behavioral Health, Treatment Communities for America, Mental Health America, National Association of City and County Health Officials, Commission on Accreditation for Residential Facilities and Joint Commission.
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