Up to half of Medicaid expansion population could have mental-health or substance-use diagnoses

By: - September 20, 2018 6:01 am

A needle used for heroin injection lies in the woods off Jeff Davis Highway in Richmond. Photo by Julia Rendleman.

Based on the experiences of other states, about 50 percent of Virginia’s newly eligible Medicaid expansion population — about 200,000 people — could have behavioral health or substance-use diagnoses.

In a presentation he made to the Joint Commission on Health Care on Tuesday, Dr. Daniel Carey, secretary of health and human resources, told lawmakers that the state departments he oversees — which are in charge of Virginia’s Medicaid and behavioral health services — are currently working on the programs that will treat those in the expansion population.

The state’s Medicaid program is due to expand by January.

Specifically, five to 10 percent of the newly eligible Medicaid members could have a substance-use diagnosis, based on the experiences of other expansion states, said Dr. Kate Neuhausen, chief medical officer with the Department of Medical Assistance Services, which manages Medicaid in Virginia.

That could vary, though. Thirty percent of West Virginia’s new Medicaid members had the diagnosis when they entered the program.

Those figures aren’t surprising considering the breadth of the opioid epidemic in Virginia and the rest of the country. Last year, both prescription and illicit opioids like heroin killed 1,229 people in Virginia.

The new members will have access to treatment for addiction thanks to a new benefit that was added to Virginia’s Medicaid program just last year: Addiction Recovery Treatment Services, or ARTS. It expanded services to all members, whereas previously they were available only to pregnant women.

Neuhausen and Tammy Whitlock, deputy director of complex care with the Department of Medical Assistance Services, told  the Joint Commission on ARTS that the number of Medicaid members with what the program terms substance-use disorder who received treatment increased by 57 percent between April 2017 and March 2018. That includes alcohol-use disorder, too.

The number of those who received treatment specifically for opioid-use disorder, meanwhile, increased by 48 percent.

That bodes well for those gaining access to Medicaid after expansion. The total number of substance-abuse care providers went up by 173 percent after ARTS was implemented, largely because the benefit provided a new revenue stream.

In preparation for the expansion population, Neuhausen said the Department of Medical Assistance Services is working with Virginia Commonwealth University to ensure the provider networks are strong enough to handle the new members.

“VCU is helping us predict where the demand for ARTS services will be,” she said, “and to look at our existing networks for ARTS and really identify any of the holes or gaps.”

During his presentation to the Joint Commission, Carey also touched on harm-reduction programs, also known as needle exchanges, which provide injection drug users with clean equipment to prevent the spread and potential outbreak of hepatitis C and HIV.

The state has already seen its hepatitis C numbers rise in the wake of the opioid epidemic.

Though Virginia legalized the programs last year, only two have been approved so far: One in Wise County, which had a soft launch of its services over the summer, and the other in Richmond at Health Brigade, formerly known as the Fan Free Clinic.

Health Brigade is still awaiting on its contract to be finalized with the Department of Health.

Carey added that a few other localities “are in various stages of application.”

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Katie O'Connor
Katie O'Connor

Katie, a Manassas native, has covered health care, commercial real estate, law, agriculture and tourism for the Richmond Times-Dispatch, Richmond BizSense and the Northern Virginia Daily. Last year, she was named an Association of Health Care Journalists Regional Health Journalism Fellow, a program to aid journalists in making national health stories local and using data in their reporting. She is a graduate of the College of William and Mary, where she was executive editor of The Flat Hat, the college paper, and editor-in-chief of The Gallery, the college’s literary magazine.