Tensions are building up between the Virginia House of Delegates and Senate as the last few days to approve a state budget pass with little progress. The budgets mostly differ on the expansion of Medicaid, with a provision to request a waiver from the federal government for expansion under the House bill, but not included in the Senate version.
In addition to providing health care for roughly 400,000 uninsured Virginians, Dr. Patrice Harris, chair of the American Medical Association Opioid Task Force, believes Medicaid could open the door to treatment for substance abusers in Virginia.
“Coverage is a precursor to receiving care,” said Harris. “Few people – let alone families living just above the poverty line – can afford to seek treatment without insurance. With Medicaid coverage, patients will be able to access treatment and recovery services that would otherwise be out of reach.”
In Virginia, the opioid epidemic continues to grow in low-income areas. In a report prepared for the Senate of Virginia in 2016 by Virginia Commonwealth University, they showed a 38 percent increase in mortality from prescription opioid and heroin overdoses between 2012 and 2014 in Virginia.
The report cited that opioid abuse is increasing because of high levels of prescription opioid drug supply, lack of understanding of the issue, and limited availability of treatment. According to the Henry J. Kaiser Family Foundation, 20 percent of nonelderly adults with opioid addiction are uninsured, and 30 percent are already Medicaid recipients.
“Specific to the opioid epidemic, Medicaid expansion will help patients get medical and psychiatric care as well as social services and behavioral therapies that would not be possible without Medicaid,” said Harris.
While some Republican lawmakers argue that Medicaid expansion helped fuel the opioid crisis, alluding to a report stating that opioids are cheaper under Medicaid and that recipients receive opioid prescriptions twice as often as non-recipients. Many argue, however, that the data is misinterpreted and that Medicaid expansion could be a vital tool in treating substance abuse.
A Health Affairs Report showed that trends in opioid deaths nationally and by Medicaid expansion predate the Affordable Care Act, and Medicaid recipients fill more opioid prescriptions that non-recipients because of more significant levels of disability and chronic illness in the populations that Medicaid serves.
A report by the Center on Budget and Policy Priorities published last month, found that states that had passed Medicaid expansion significantly increased coverage for people with opioid-use disorders. Under current Virginia Medicaid requirements, low-income adults with substance abuse disorders don’t qualify for Medicaid unless they also have a physical or mental health disability.
After expanding healthcare, Kentucky, for instance, experienced a 700 percent increase in Medicaid recipients using substance abuse treatment services.
Last year the state implemented the Addiction and Recovery Treatment Services (ARTS) initiative that increased access to treatment for opioid and other substance use disorders in Virginia. Under the program, more than half of Virginia Medicaid recipients with an opioid use disorder (OUD) received treatment.
In the first five months of the program, 5,200 Medicaid recipients received OUD treatment, and the number of Medicaid recipients receiving treatment for an opioid addiction increase 52 percent. Virginia also saw fewer prescriptions for opioid pain medications and fewer emergency room visits related to opioid disorders among Medicaid recipients.
Earlier in the session, a key Virginia Republican lawmaker announced his support for Medicaid expansion. Del. Terry Kilgore from Southwest Virginia cited addressing the opioid crisis that plagues his region as a reason to stand behind Medicaid expansion.
At least two Virginians die from prescription opioid or heroin overdoses every day. Last year a report found that three Southwest Virginia towns – Martinsville, Norton City and Galax – are among the top five jurisdictions with the highest number of opioid prescriptions per capita in the nation.
The governor has already signed a few bills aimed at the opioid crisis in Virginia, many pertaining how they are prescribed and monitored.