Red Tape, Varying Rules Limit Medicaid Coverage for Addiction

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In an opioid epidemic that is killing tens of thousands of people nationwide, finding and paying for addiction treatment remains a challenge for low-income Americans, particularly in the South and parts of the West, reports Stateline. The Affordable Care Act required Medicaid, the state-federal health program for the poor, to start paying for all available substance abuse treatments in 2014, a provision seen as a boon for low-income people who previously were not covered for addiction treatment. Medicaid coverage of the most widely used opioid addiction medication, buprenorphine, varies widely among states. Many doctors don’t want to treat Medicaid patients for addiction. Red tape can make it difficult for many Medicaid recipients with addictions to get effective treatment.

All this has consequences as the nation battles the epidemic. Medicaid enrollees suffer from opioid addiction and other substance abuse disorders at a higher rate than the general population. “What we see in far too many Medicaid plans are restrictions and approaches to addiction treatment that are not in line with the way we treat other diseases,” said Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine (ASAM). “Some plans require patients to wean off of their addiction medications. Would you tell a heart patient he needs to taper off of his medication after a year?” All states reimburse for the medication, but in many places, the fees Medicaid pays doctors are considered too low and the paperwork too time-consuming to attract an adequate number of providers willing to treat Medicaid enrollees with addictions.


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