Opioid bill headed to Trump would improve access to residential drug treatment, a major problem in rural areas

Congress has passed a big bill to fight the opioid epidemic, and President Trump says he will sign it. "Addiction treatment advocates say two provisions — one that would allow Medicaid, the federal-state health insurance plan for the poor, to pay for residential treatment in large facilities; and another that would allow Medicare, the federal health plan for people 65 and older, to pay for methadone treatment — will substantially improve access to treatment," Christine Vestal reports for Stateline, a service of the Pew Charitable Trusts. Access to treatment is a big problem in rural areas.

The 1965 Medicaid law says the program can't pay for mental-health and addiction treatment in facilities with more than 16 beds. The “institutions for mental disease” (IMD) exclusion "was intended to prevent states from using federal dollars to warehouse people with addiction and mental disorders," Vestal notes. But a later law allowed federal officials to waive the rule, and more than half the states have received or applied for waivers because of the opioid epidemic.

The opioid bill "is designed to make it easier for even more states to get similar approval," Vestal reports. Getting a waiver has been "typically an arduous and lengthy regulatory process."

Matt Salo, executive director of the National Association of Medicaid Directors, told Vestal, “This provision alone will go a long way to improving both the quality of addiction treatment and its availability to low-income people.”

However, the National Council for Behavioral Health "is disappointed that the legislation did not do more to fund community-based addiction treatment," Vestal reports. That is often the most available alternative in rural areas.