In about nine months, Medicaid is scheduled to begin paying for about a 30-day stay at a residential drug treatment center, according to state officials.
The state Department of Health and Human Resources anticipates Medicaid will also begin paying for methadone and the overdose reversal drug naloxone, including referrals to treatment that first responders would make after responding to an overdose, in January. Medicaid billing for peer recovery support services would begin in July.
About 30 percent of West Virginians are covered by Medicaid. DHHR announced Tuesday that the Centers for Medicare and Medicaid Services (CMS) had sent a letter on Friday informing state officials that West Virginia had received a waiver allowing Medicaid to cover additional drug treatment services.
“I had tears in my eyes,” said Cindy Beane, commissioner of the DHHR’s Bureau for Medical Services. “That’s how excited I am to get services out there to people who are literally dying for these types of services.”
In July 2015, CMS sent states a letter, informing them of a substance use disorder treatment waiver program. Under Section 1115 of the Social Security Act, the secretary of the U.S. Department of Health and Human Services can waive certain Medicaid rules. In the letter, CMS told state officials that under Section 1115, they could “test Medicaid coverage” of more types of substance abuse treatment, but must demonstrate improved care and be budget-neutral.
The DHHR applied in November 2016 for permission to conduct a five-year project. DHHR officials previously have said they were in “negotiations.” Beane said Tuesday they had hoped for funding for Recovery Point.
“They said we are not going to pay for recovery housing,” she said. “I feel like we got everything else.”
Beane said West Virginia has five years to show the project pays for itself — by ensuring patients get “the right treatment at the right time.” She mentioned, as an example, that emergency room visits due to overdoses would be expected to decline.
Medicaid does not pay for addiction treatment at “institutions of mental disease” with more than 16 beds, due to a 1965 rule enacted during the push to move patients from state psychiatric hospitals to community-based services. Beane said the waiver would allow Medicaid to pay for services at residential treatment facilities, such as Prestera’s Pinecrest facility in Huntington.
Medicaid will also begin to pay for peer recovery services. Facilities like Rea of Hope and Recovery Point in Charleston offer peer recovery services, but would need to become licensed behavioral health centers.
Methadone clinics would also have to be licensed by the Bureau for Medical Services.
First responders could bill for “screening, brief intervention and referral to treatment,” according to the plan. Beane said they could bill to make referrals “at the point the person is in crisis.”
Beane expects the number of residential treatment centers in the state to increase, in part due to the waiver, and in part due to the Ryan Brown Addiction Prevention and Recovery Fund. Applications for that funding, which comes from settlements with drug distributors, were due last week.
“This is very exciting news for West Virginia,” Beane said.
Highland currently offers detox services at its Highland Health Center, but not at Highland Hospital. Jessica Carter, business development specialist, said patients would be able to detox at the hospital once the waiver takes effect. She said the waiver would also allow them to stay for 28 days, once the fourth floor of the hospital undergoes renovations.
Tom Price, the former HHS secretary who resigned over private jet travel, and President Donald Trump, whose wife, Melania, visited a neonatal abstinence syndrome treatment facility in Huntington on Tuesday, both supported Affordable Care Act repeal efforts, which would have kicked at least 170,000 people off Medicaid in West Virginia. That’s how many people state officials say are covered by Medicaid expansion. Don Wright, the acting assistant secretary for health at HHS, was named acting secretary less than two weeks ago.
Allison Adler, a DHHR spokeswoman, has previously said a GOP repeal bill “would not prohibit the approval of this waiver; however, the 50,000 expansion members would be left out without services through Medicaid.” She was referring to the about 50,000 people who are covered by Medicaid expansion, a provision of the Affordable Care Act, and who have substance use disorders.
“Rolling back Medicaid coverage in and of itself hurts West Virginia because we are so dependent on Medicaid coverage to help our low-income and middle-income patients,” Carter said. “It hurts babies. It hurts their mothers. It hurts when those babies become children and need coverage.”
That need for coverage “doesn’t stop when the baby is detoxed,” she said.
She called the waiver “a very needed first step.” Cynthia Persily, CEO of Highland, called it “a tool in our expansion of services,” in a statement.
Sen. Shelley Moore Capito, R-W.Va., and Sen. Joe Manchin, D-W.Va., had pushed for the approval, according to a DHHR news release.