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As Virginia has grappled with the ongoing opioid epidemic, the overwhelming need for treatment has made room for cash clinics and pill mills to squeeze through loopholes that the state is trying to close.

Southwest Virginia especially has been seeing cases where doctors require patients to pay cash for both prescription opioid painkillers and drugs like methadone, which is used to treat addiction, according to Medicaid officials.

In 2017, the state’s Medicaid program initiated the Addiction and Recovery Treatment Services, or ARTS, program, which significantly expanded access to what officials refer to as “high-quality” treatment services. But some Medicaid patients are still going to cash clinics for services, unaware that better treatment options are covered, said Kate Neuhausen, chief medical officer with the Virginia Department of Medical Assistance Services.

“They may be like the pregnant woman who came up to me at an event and said, ‘I’ve been paying $100 a week for methadone, I had no idea Medicaid would pay for it, I couldn’t make the mortgage payment on my house because of my methadone, and I’m losing my house,” Neuhausen said.

Legislation to prohibit physicians from taking cash from Medicaid patients for opioid pain management or medication-assisted-treatment, which refers to the practice of prescribing patients drugs like methadone to treat their addictions, passed its first committee unanimously on Thursday.

“This bill addresses the bad actors who could participate in Medicaid, but they opt out,” the bill’s sponsor, Del. Todd Pillion, R-Washington County, told the House Health, Welfare and Institutions committee.

Neuhausen said Medicaid’s ARTS program has a very strong network of opioid-use disorder treatment providers that will cover those who are currently going to cash clinics. The bill would require that those offering treatment be an in-network provider, meaning they have to be credentialed by one of the state’s six Medicaid health plans.

Doug Gray, executive director of the Virginia Association of Health Plans, said his group supports the bill “wholeheartedly.”

“This has been a problem for many years and we’ve been trying to figure out how to get to it,” he said.

Opioid addiction treatments work best when they’re offered in conjunction with counseling and trauma-informed care, Neuhausen said in an interview. People aren’t turned away for refusing counseling, she added, but the best providers are those that offer both counseling and medication treatment, unlike cash clinics.

Some of these cash clinics might give a patient a months-long supply of suboxone, another drug used in medication-assisted-treatment, and also co-prescribe a potentially dangerous medication like benzodiazepines or Adderall, Neuhausen said.

“So then the member would go get the prescription and sell part of it to have enough cash to come back and pay the physician,” she said. “It really can fuel the black market and just lead to low-quality outcomes.”

Medicaid expansion means that thousands more Virginians will have access to the ARTS program and a new avenue for treatment. But that’s why it’s all the more important, Neuhausen said, to educate members about their coverage options and deter them from going to these “bad actors.”

“It’s really great to have built the foundation of services first and now to be able to give all these people, many of whom have had nothing, to really have access to high quality treatment,” she said. “But that’s why this bill is so important to make sure they come into our ARTS network.”

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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.