In the throes of an opioid epidemic that killed more than 33,000 people in 2015, the nation’s supply of residential treatment slots falls far short of the number needed to serve everyone who walks in, gets dropped off by police, or is transferred from a hospital or crisis center. Waitlists persist almost everywhere, primarily because of a growing number of people addicted to heroin and prescription painkillers, reports Stateline. To boost the number of beds available for low-income residents, the federal government has granted California, Maryland, Massachusetts and New York a waiver of a Medicaid rule that prohibits the use of federal dollars for addiction treatment provided in facilities with more than 16 beds. Seven other states — Arizona, Indiana, Illinois, Kentucky, Michigan, Utah and Virginia — are seeking similar permission.
Last month, Health and Human Services Secretary Tom Price told governors that the agency would continue the Obama administration’s waiver policies for residential facilities with 16 or more beds. The 16-bed provision was originally intended to discourage investment in what the 1965 Medicaid law called “institutions for mental disease,” and to instead promote the expansion of smaller, community-based mental health and substance abuse centers. Sidestepping the 16-bed prohibition means millions in new federal Medicaid dollars will flow to treatment centers that now rely on limited state and local grants. The federal government is encouraging all states to seek a waiver of Medicaid’s residential treatment rule, but only if the care is offered as part of a comprehensive set of addiction services for low-income people.