Medicaid Provisions in the SUPPORT Act

Health Update

Editor’s Note: In October, President Trump signed into law the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act). In a new article for The Commonwealth Fund blog, Manatt Health examines the important steps forward the SUPPORT Act takes in helping prevent new addictions; expand access to treatment, including medication-assisted treatment (MAT); promote harm-reduction strategies; and authorize pilots to experiment with approaches for expanding provider capacity. The article also reveals the gaps the law leaves unfilled—including the need for sustained funding to expand community-based care for substance use disorders. Key points are summarized below. Click here to access the full blog post free.

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Compared with commercial insurance, Medicaid often takes the lead on addressing the opioid epidemic. There are still gaps, however, in Medicaid coverage of substance use disorder treatment. Fifteen states do not yet cover all forms of medication-assisted treatment. Moreover, states have been precluded from using Medicaid federal funds to provide care for beneficiaries between ages 21 and 64 residing in Institutions for Mental Disease (IMDs).

The SUPPORT Act takes some important steps to address these issues:

  • Mandatory coverage of MAT. For fiscal years (FYs) 2020–25, all state Medicaid programs must cover MAT and related treatments, including counseling and behavioral health services.
  • State option to provide IMD services. For FYs 2019–23, states can use Medicaid funds to cover IMD services for people with at least one substance use disorder for 30 days over a 12-month period, provided the states offer the full continuum of care (including outpatient services and support transitioning back to the community). States also must ensure that IMDs offer at least two forms of MAT.
  • Additional enhanced funding for substance use disorder health homes. The law authorizes an additional two quarters (for a total of 10) of 90% Medicaid funding for the care coordination and management services offered by substance use disorder health homes established after the start of FY 2018.
  • Demonstration project on increasing capacity. The SUPPORT Act includes a 54-month Medicaid demonstration project for a limited number of states. Up to 10 states can receive planning grants to develop a strategy for increasing substance use disorder treatment capacity, particularly with respect to MAT. Five of those states will be selected to implement their strategy. For the three-year duration of the demonstration, Medicaid will match 80% of the cost of treatment of recovery services that exceeds FY 2018 spending levels.

Conclusion

The changes the SUPPORT Act introduces will likely lead to improvements in opioid use disorder prevention and treatment, but solving the epidemic requires greater and permanent investments. The bill adds only $2.1 billion to Medicaid for FYs 2019–28, or less than one-tenth of 1% of total Medicaid funding over this period.

More funding for care provided through Medicaid would likely be required, as it is the single-largest source of coverage for people with opioid use disorders, serving nearly four of ten such individuals. To adequately address the opioid crisis, states would likely need Medicaid to cover all appropriate treatment options and to have enough providers to serve beneficiaries.