Repeal of the Medicaid expansion under the Affordable Care Act could put substance abuse treatment at risk for West Virginians receiving care under Medicaid, according to an expert from the Center on Budget and Policy Priorities, a progressive think tank.
West Virginia has taken advantage of the opportunity provided by the Medicaid expansion to deliver comprehensive care for addiction, said Judy Solomon, vice president for health policy at the organization,
Current Medicaid coverage for substance abuse disorders provides treatment such as outpatient recovery services, partial hospitalization and medication and counseling for opioid addiction, but the state is also attempting to provide additional coverage.
West Virginia’s Department of Health and Human Resources submitted a request to the federal government last month that would enable the state to provide coverage for residential treatment for substance abuse disorders under Medicaid. That request has not yet been approved, putting its future in doubt under a Trump administration.
West Virginia has seen one of the highest drops in uninsured in the nation since implementation of the Affordable Care Act. Between 2013 and 2015, the state saw its uninsured rate go from 14 percent to 6 percent, according to the U.S. Census Bureau.
If the ACA were partially repealed, West Virginia is projected to see a 208 percent increase in the number of uninsured residents by 2019, potentially affecting health coverage for 184,000 West Virginians, according to a report by the Urban Institute.
President-elect Donald Trump and Republicans in Congress have touted changes in Medicaid funding such as block grants, which would provide fixed amounts of money annually for states to spend on Medicaid, but Solomon said changes like these could have consequences for coverage.
A switch to block grants or per-capita caps, which would put limits on federal Medicaid spending per beneficiary, Solomon said, could lead to restrictions on coverage such as work requirements or cuts for certain groups. In Kentucky, a plan submitted to the federal government for review in August would put a work requirement in place for Medicaid beneficiaries to continue receiving coverage.
Republicans, including Trump and House Speaker Paul Ryan, have argued that block grants give states more flexibility to manage Medicaid according to each state’s unique needs. “This,” Solomon said on the press call, “is really a false promise.”
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