Substance Use Disorders (SUD) impact the lives of millions of Americans in the general population, including individuals that are enrolled in the Medicaid program. Nearly 12 percent of Medicaid beneficiaries over 18 have a SUD, and CMCS is committed to helping States effectively serve individuals with SUDs. On average, 105 people die every day as result of a drug overdose. Additionally, 6,748 individuals across the country seek treatment every day in the emergency department for misuse or abuse of drugs. In 2010, drug overdose was the leading cause of injury death and caused more deaths than motor vehicle accidents among individuals 25-64 years old. The monetary costs and associated collateral impact to society due to SUDs are very high. In 2009, health insurance payers spent $24 billion for treating SUDs. Of the $24 billion, Medicaid accounted for 21 percent of the spending. The evidence is strong that treatment in managing SUDs provides substantial cost savings. For instance:
- Persons with untreated alcohol use disorders use twice as much health care and cost twice as much as those with treated alcohol use disorders; and medications treating substance use disorder in pregnant women resulted in significantly shorter hospital stays than drug-addicted pregnant women not receiving MAT (10.0 days vs. 17.5 days).
- For inpatients with alcohol dependence, MAT was associated with fewer inpatient admissions. Total healthcare costs were 30 percent less for individuals receiving MAT than for individuals who not receiving MAT.
- Medical costs decreased by 30 percent on average between the year prior to MAT and the third year following treatment, and these cost trends reflect a decline in expenditures in all types of health care settings including hospitals, emergency departments, and outpatient centers.
- Methadone treatment has been found to generate $4 to $5 in returns on healthcare expenditures for every $1 invested.
- Early intervention in the cycle of addiction for younger individuals with substance use disorders can bring costs down as they have lower pre-treatment costs than older adults with substance use disorders.
CMS is encouraged with the increased interest by states to develop effective strategies for developing benefit designs for this population. Many states have included behavioral health services for individuals with SUD in the State Plans and various Medicaid managed care Waivers. The following resources are available to States:
- State Health Official Letter: Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment (PDF, 206.49 KB) - December 2020
- CMCS Informational Bulletin: Support for Family-Focused Residential Treatment-Title IV-E and Medicaid Guidance (PDF, 233.31 KB) – October 2020
- CMCS Informational Bulletin: Guidance to Improve Care for Infants with Neonatal Abstinence Syndrome and Their Families (PDF, 433.4 KB) – September 2020
- State Medicaid Director Letter: SUPPORT Act – IMD State Plan Option – November 2019
- CMCS Informational Bulletin: Help for Moms and Babies -Medicaid Coverage for services to Pregnant/Post-partum Women Outside of an IMD (Section 1012)
- CMCS Informational Bulletin: SPA Residential Pediatric Recovery Center – Guidance to States (Section 1007)
- Report to Congress: SUPPORT Act Section 1018: Action Plan (PDF, 49.97 KB)
- CMCS Informational Bulletin: Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants
- State Medicaid Director Letter: Leveraging Medicaid Technology to Address the Opioid Crisis
- State Medicaid Director Letter: Strategies to Address the Opioid Epidemic
- CMCS Informational Bulletin: Best Practices for Addressing Prescription Opioid Overdoses, Misuse and Addiction
- CMCS Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders
- CMCS Informational Bulletin: Delivery Opportunities for Individuals with a Substance Use Disorder
- CMCS Informational Bulletin: Medication Assisted Treatment for Substance Use
Coverage and Deliver of Adult Substance Abuse Services in Managed Care
This issue brief (PDF, 149.98 KB) explores state strategies with respect to purchasing substance abuse services for adult Medicaid beneficiaries, with a particular focus on states that use managed care for the purchase and delivery of physical health services. The brief reviews the current landscape of substance abuse coverage in Medicaid managed care states and the paradigm shift created by the ACA Medicaid expansion in terms of substance abuse eligibility, benefits, and provider capacity. A webinar (PDF, 839.54 KB) on this topic was held on September 24, 2014.