logo logo
Donate
    • Membership
    • Donate
  • Social Justice
    • Racial Justice
    • Climate Justice
    • Disability Justice
    • Economic Justice
    • Health Justice
    • Immigration
    • LGBTQ+
  • Civic News
  • Nonprofit Leadership
    • Board Governance
    • Equity-Centered Management
    • Finances
    • Fundraising
    • Human Resources
    • Organizational Culture
    • Philanthropy
    • Power Dynamics
    • Strategic Planning
    • Technology
  • CONTENT TYPES
  • Leading Edge Membership
  • Newsletters
  • Webinars

Do You Trust Your State? GOP Health Bill Drops Medicaid Addiction Treatment Mandate

Michael Wyland
March 15, 2017
“Drug overdose” By Sam Metsfan (Apartment in New York) [Public domain], via Wikimedia Commons

March 9, 2017; Washington Post

The American Health Care Act (AHCA), proposed by House Republicans and endorsed by the Trump administration, includes key provisions that eliminate federal mandates for what services must be covered under Medicaid. Among these changes is one that could affect an estimated 1.3 million people in need of addiction treatment in the 31 states and the District of Columbia that chose to implement Medicaid expansion under the Affordable Care Act (ACA).

There is concern about ending the coverage mandate at the same time a national opioid epidemic is spreading across the country. The Washington Post reports:

A record number of people—33,000—died of opiate overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun-related homicides. Authorities are also grappling with an influx of powerful synthetic narcotics responsible for a sharp increase in overdoses and deaths over the past year.

Opioid overdose death rates are highest in Kentucky and West Virginia, both states that expanded Medicaid under the ACA. Medicaid currently pays for about 44 percent of medication-assisted addiction treatment for covered individuals in those states.

If the AHCA were to become law in its present form, the federal mandate under Medicaid expansion would disappear. However, whether addiction treatment coverage would also disappear in those states is a more difficult question to answer, owing to economics, politics, and existing state laws.

Sign up for our free newsletters

Subscribe to NPQ's newsletters to have our top stories delivered directly to your inbox.

By signing up, you agree to our privacy policy and terms of use, and to receive messages from NPQ and our partners.

Federal Medicaid funding would shift from a percentage of covered expenses (reimbursements for services provided and paid for) to a percentage of covered individuals (a fixed dollar amount per eligible Medicaid recipient). The bill’s proponents believe that the change is a win-win; the federal government will save money and states will have more latitude to implement Medicaid coverage based on state-identified needs.

Critics note that a person’s Medicaid eligibility and enrollment varies from month to month, especially for nondisabled enrollees younger than retirement age. Addiction is a “chronic relapse disease,” meaning that someone receiving treatment under Medicaid expansion might be successful in returning to work and no longer qualify for addiction treatment services under Medicaid expansion. If they were to subsequently relapse into addiction, under the proposed AHCA they would not be able to requalify for the same benefits.

According to the nonpartisan National Council of State Legislatures (NCSL), all states have at least some form of mental health parity mandate or regulation. The ParityTrack website provides additional state-by-state information on the details of legislation, regulation, and litigation related to mental health insurance coverage parity. Each state’s approach and extent of parity is different, making it all but impossible to know what would happen in the absence of federal mandates.

Further complicating the ability to predict is the very freedom guaranteed to state Medicaid administration under the AHCA. Would states elect to continue addiction treatment coverage under the same terms as before? Would state-level mental health parity laws apply to Medicaid plans? Could state governments afford to maintain coverage if Medicaid funding is reduced and other treatment priorities—and other providers—are demanding support?

Advocates for addiction treatment would be wise to watch events at both the federal and state levels. Although it’s possible that the AHCA will be defeated or amended, it’s likely that President Trump and HHS Secretary Tom Price, with or without Congressional support, will direct changes in federal Medicaid regulations in such a way as to make state-level mental health parity laws and state Medicaid policies crucial to continued coverage for addiction services.—Michael Wyland

About the author
Michael Wyland

Michael L. Wyland currently serves as an editorial advisory board member and consulting editor to The Nonprofit Quarterly, with more than 400 articles published since 2012. A partner in the consulting firm of Sumption & Wyland, he has more than thirty years of experience in corporate and government public policy, management, and administration.

More about: Health JusticeNonprofit NewsPolicy

Our Voices Are Our Power.

Journalism, nonprofits, and multiracial democracy are under attack. At NPQ, we fight back by sharing stories and essential insights from nonprofit leaders and workers—and we pay every contributor.

Can you help us protect nonprofit voices?

Your support keeps truth alive when it matters most.
Every single dollar makes a difference.

Donate now
logo logo logo logo logo
See comments

You might also like
For Black Maternal Health, We Need Justice and Equity: A Conversation with Angela Doyinsola Aina
Rebekah Barber
Why Guardianship Reform Is a Civil Rights Imperative
James A. Lomastro
Advocates Seek to Protect Children with Disabilities from Federal Cuts
María Constanza Costa
With Major Sponsors Out, Who Is Stepping Up to Support Pride?
Alison Stine
Burnout Among the Youngest Climate Activists
Alison Stine
Advocates Discuss How Best to Support the Autism Community
Matthew Rozsa

Upcoming Webinars

Group Created with Sketch.
June 26th, 2:00 pm ET

From Performance Management to Mutual Commitment

Fostering a Culture of Joyful Accountability

Register
Group Created with Sketch.
July 24th, 2:00 pm ET

Organizing in Divided Times

The Relational Infrastructure We Need to Protect Democracy

Register

    
You might also like
A group of about two dozen students, many wearing blue shirts, walk in the rain in front of the US House of Representatives.
How Nonprofits and Activists Can Oppose Trump’s “Big...
Matthew Rozsa
A smiling young Black pregnant woman stands indoors with her hands gently resting on her belly.
For Black Maternal Health, We Need Justice and Equity: A...
Rebekah Barber
A chain and padlock keep the fence closed and block through access on a country road.
Why Guardianship Reform Is a Civil Rights Imperative
James A. Lomastro

Like what you see?

Subscribe to the NPQ newsletter to have our top stories delivered directly to your inbox.

See our newsletters

By signing up, you agree to our privacy policy and terms of use, and to receive messages from NPQ and our partners.

  • About
  • Advertise
  • Careers
  • Contact
  • Copyright
  • Donate
  • Editorial Policy
  • Funders
  • Submissions

We are using cookies to give you the best experience on our website.

 

Non Profit News | Nonprofit Quarterly
Powered by  GDPR Cookie Compliance
Privacy Overview

This website uses cookies so that we can provide you with the best user experience possible. Cookie information is stored in your browser and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful.

Strictly Necessary Cookies

Strictly Necessary Cookie should be enabled at all times so that we can save your preferences for cookie settings.

If you disable this cookie, we will not be able to save your preferences. This means that every time you visit this website you will need to enable or disable cookies again.