Medicaid participants must have access to all opioid treatments, says Capito

The Trump administration must take immediate action to address a decision by the Centers for Medicare and Medicaid Services (CMS) that could negatively affect access to treatment for opioid addiction, according to U.S. Sen. Shelley Moore Capito (R-WV) and a bipartisan, bicameral group of West Virginia lawmakers concerned about their home state’s efforts to battle the ongoing drug crisis and the COVID-19 pandemic.

The delegation is concerned about CMS’s interpretation of Section 1006(b) of the 2018 law, SUPPORT for Patients and Communities Act, that seeks to ensure access for Medicaid beneficiaries to all forms of Medication-Assisted Therapy (MAT) used to treat opioid dependence. 

CMS has informed states that beginning on Oct. 1, implementation of the provision will change the way they can finance the purchase of these medications, resulting in higher costs for each state’s Medicaid program, and could cause drug therapy interruptions and discontinuations, according to a Sept. 17 letter the lawmakers sent to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and CMS Administrator Seema Verma. 

“As you know, the opioid epidemic remains a public health emergency and is worsened by the coronavirus” public health emergency (PHE), wrote Sen. Capito and her colleagues. “Access to treatment is as critical as it was when the SUPPORT Act was enacted.

“As states grapple to accommodate increasing health costs in the face of decreasing revenue, it is essential the [administration] approach its SUPPORT Act implementation in a manner that empowers the states to effectively address the dual public health crises they face,” wrote Sen. Capito and the delegation, which included U.S. Sen. Joe Manchin (D-WV) and U.S. Reps. David McKinley (R-WV), Alex Mooney (R-WV), and Carol Miller (R-WV).

They pointed out that Section 1006(b) of the SUPPORT Act was intended to address the fact that several states were not covering all forms of MAT with a five-year coverage mandate.

“We have assured health system leaders in our states that Congress did not intend to simultaneously increase state coverage obligations and reduce Medicaid revenue sources,” Sen. Capito and her colleagues wrote. “We strongly encourage HHS and CMS to act quickly and decisively to utilize the types of flexibilities the administration has implemented to address the coronavirus PHE to avoid the grim clinical implications of CMS’ statutory interpretation.”