State sees increase in addiction treatment access as lawmakers consider expanding care
Drug paraphernalia lies on the floor inside an abandoned home in Appalachia, Va., where neighbors say the previous residents cooked meth before they were arrested. (Ned Oliver/ Virginia Mercury)
A state agency is reporting substantial gains in addiction treatment under Virginia’s Medicaid expansion — a report that comes as lawmakers consider several budget proposals to expand the continuum of care for substance use disorders.
The state unrolled new addiction treatment services in 2017, when 1,536 state residents died of fatal overdoses. That year, Virginia Medicaid launched a new benefit called Addiction and Recovery Treatment Services (ARTS), which expanded Medicaid coverage for inpatient detoxification, residential treatment and other addiction-related services.
At the time, Virginia was one of the “leaders in the nation” when it came to covering addiction treatment through Medicaid, said Karen Kimsey, director of the state’s program. A new two-year evaluation, published by researchers with the Department of Health Behavior and Policy at Virginia Commonwealth University, found that treatment rates more than doubled among Medicaid patients in the first two years of the program.
“ARTS has had a profound impact on access to addiction treatment services for the Medicaid population,” said Peter Cunningham, the lead author of the report. “It’s a continuation of the trend we saw after the first year that showed this program has really been effective.”
The reach has only grown since lawmakers approved Medicaid expansion. In the first three months after coverage took effect — on Jan. 1, 2019 — 12,000 new patients with substance use disorders enrolled in health care coverage. The ARTS program, combined with health care expansion, has offered more resources to more patients as the state aggressively pursued more treatment options for Medicaid patients.
Because of low reimbursement payments to doctors, many providers choose not to accept the Medicaid, limiting options for low-income patients.
But Kimsey said the state worked with providers and consulted the commercial market to raise reimbursement rates for addiction services. During the second year of the ARTS program, more than 4,000 practitioners billed Virginia Medicaid for addiction treatment services. The state’s Department of Health also helped providers become certified to prescribe buprenorphine — a medication used in addiction treatment.
According to the study, the state’s efforts paid off. The number of doctors prescribing buprenorphine grew by 73% between 2016 and 2018. Two-thirds of those providers reported accepting new Medicaid patients or had a paid Medicaid claim in 2018.
“This is still very new, but what we’re seeing is very encouraging,” Kimsey said. In total, the state saw treatment rates climb to 49% among base Medicaid patients during the first two years of ARTS. Emergency department use and inpatient hospital care for all substance use disorders also decreased by 7% since the year before the program started (and by 32% for opioid use disorder). That’s significant, given that emergency care can lead to hefty medical bills for services that are better delivered by other providers.
Fatal drug overdoses were projected to increase slightly in 2019 after the first decline in more than a decade. Kimsey said the department is also working to address existing gaps in service, including the one in six Medicaid patients who return to residential addiction treatment programs within 30 days after their initial discharge.
“That’s a problem we’re seeing nationally,” she said. “Individuals often relapse after treatment, and I need to compare how we’re doing compared to other states.”
But the department is touting the successes of the program as lawmakers consider possible extensions. One key aspect of the ARTS program was a dramatic increase in office-based opioid treatment programs, which offer medically assisted treatment (such as buprenorphine) in the same space as counseling and other support services.
There’s some evidence that comprehensive services can increase the success of addiction treatment., Gov. Ralph Northam’s proposed budget includes a $1,273,633 general fund request in 2022 to expand the model to all substance use disorders.
“We’re still in the process of assessing the benefits,” Cunningham said. “But it’s important to consider that most people with substance use disorders have other health problems. They have other mental health problems, physical health problems, and it’s important from the standpoint of treatment that those problems are treated in coordination.”
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