The historical arc of access to substance use services may understandably make one prone to ignore Medicaid. Often, substance use responses were housed in punitive, not healing systems. However, 21st-century legislative and system changes have begun to shift that reality, albeit unequally. Health responses for people who use drugs have become an important element in saving lives and improving their well-being. Although overdose deaths are declining in many populations, they remain high. Substance use (SU) services also prevent deadly diseases like HIV, Hepatitis C, and bacterial endocarditis. Comprehensive physical, mental, and substance use health services reduce costly illnesses for individuals, families, and the healthcare system. Preventing just one case of HIV saves over $300,000 in medical costs.
Medicaid is currently the main funder of mental health, substance use, and physical health care for this population. It has played an important part in decreasing overdose rates. As the single largest payer of behavioral health services, Medicaid provides essential, often otherwise unaffordable, care to children, youth, and adults. For example, buprenorphine, an important medical treatment for opioid use disorder, can cost up to $6,000 a year in parts of the country; this cost is solely for the medication, not the provider visits or any other services. Medicaid covers this life-saving medication. Administrative changes and legislation like H.R.1 (OBBBA) put this coverage at risk through complicated work reporting requirements, huge cost-shifts to states and other changes. Many people do not understand the importance of Medicaid, but without it, people lose access to critical health services and possibly their lives. Join us for this conversation to protect Medicaid’s role in supporting the well-being and rights of people who use drugs.
Speakers:
- Kay Johnson, President, Johnson Policy Consulting
- Dr. Kimá Joy Taylor, Founder, Anka Consulting
- Silvana Mazzella, Lead Executive Officer, Prevention Point
Moderator: Anne Dwyer, Associate Research Professor, Georgetown Center for Children and Families
Download the Presentation Slides
This webinar is apart of a larger series, Medicaid Connections.
Resources
General Links:
- A Brief History of Federal Policy Regarding Maternal Mental Health and Substance Use – Kay Johnson
- How Medicaid Helps People with Substance Use Disorders
- Medicaid’s Role in Child, Youth and Adult Mental Health
- Medicaid, CHIP, and Affordable Care Act Marketplace Cuts and Other Health Provisions in the Budget Reconciliation Law, Explained
- Work Reporting Requirements – Center For Children and Families
- Status of State Medicaid Expansion Decisions | KFF
- More on Medicaid EPSDT Behavioral Health Toolkit
- States are Sending Initial Outreach Notices about Medicaid Work Reporting Requirements. What Do They Look Like?
National Resources on Substance Use:
- CDC: Opioid Use and Pregnancy.
- SAMHSA: A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders.
- American College of Obstetricians and Gynecologists (ACOG) Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy.
- SAMHSA: Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health
- Medscape CDC Expert Commentary: What We Can Do About Opioid Use Disorder in Pregnancy
- American Academy of Pediatrics: Clinical Report—Neonatal Opioid Withdrawal Syndrome
- Policy Center for Maternal Mental Health. Substance Use Disorder and Maternal Mental Health. Fact Sheet. March, 2025. https://www.doi.org/10.69764/SUDF2025
Additional Reading:
- Taylor KJ. A Different Vision: Centering Love Not Punishment for Families Affected by Substance Use. Maternal and Child Health Journal. 2023;27:S182-S186. https://doi.org/10.1007/s10995-023-03843-w.
- Taylor KJ, Benatar S. The pandemic has increased demand for data and accountability to decrease maternal health inequity. Issue Brief. Urban Institute. December, 2020.
- Roberts SC, Thompson TA, Taylor KJ. Dismantling the legacy of failed policy approaches to pregnant people’s use of alcohol and drugs. International Review of Psychiatry. 2021;33(6):502-13.
Questions Not Answered Live:
Q: A lot of states have implemented the 1115 Reentry Waiver that allows some duration of pre-release case management services and post-release follow up + access to full Medicaid benefits (for incarcerated individuals). Do we know of any states across the US that do not terminate or suspend coverage for any duration of incarceration?
Under the inmate exclusion policy in the Medicaid statute, pre-release benefits are generally time limited under the existing 1115 waiver option and corresponding CMS guidance. KFF has a tracker of state 1115 waivers can be found below (see Table 1, and select “justice-involved”)
Q: States could benefit from allowing eligibility to continue while incarcerated, especially for those who need MAT or MOUD treatment. I wonder if there are any conversations happening (outside of the waiver) to explore the possibility of this.
The Health and Reentry Project works at the interaction of health care and the criminal justice system and is a great resource.