Short-term grants are no replacement for Medicaid to fight opioid epidemic

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As the Senate considers the House-passed American Health Care Act (AHCA) some Senators, worried about the potential effects of the proposed Medicaid cuts on their constituents suffering the effects of the opioid epidemic, are considering adding billions of dollars in state grant funding to provide treatment to compensate.

Grant funding is not unwelcome, and is surely better than cutting Medicaid with no other source of federal treatment dollars, but it is a poor and insufficient replacement for the consistent and scalable funding that Medicaid provides.

{mosads}As a physician, I know that healthcare providers cannot rely on grant funding to run their practices. Because it’s unpredictable and often delayed, subject to the whims of the appropriations process and uncertainty of re-authorization, we cannot depend on it to hire staff or pay the rent. It also requires applications and reporting that fall outside the normal workstream of physician practices, making it impractical for many providers to incorporate it into their business model.


Medicaid is the largest and most significant source of coverage and funding for addiction treatment in our country. In states hit hardest by the opioid epidemic, including my home state of Kentucky, Medicaid covers 35 to 50 percent of all medication-assisted treatment for opioid addiction, the treatment that research shows is most effective in reducing the opioid overdose death rate and keeping people in treatment.

In states like Kentucky that expanded Medicaid, the share of people with substance use disorders or mental illness who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015, and Medicaid expansion has been associated with an 18.3 percent reduction in the unmet need for substance use disorder treatment services among low-income adults. These results are significant and newsworthy, and they are in jeopardy of being quickly reversed.

Moreover, moving away from Medicaid to federal grant programs moves us backward toward separate and unequal treatment systems for addiction and all other medical conditions. At a time when we are making great progress to integrate addiction and mental health treatment into general medical care, this change would move us several steps backward toward siloed treatment systems.

Access to treatment is not only a public health imperative; it’s an economic one. In Kentucky, there are thousands of unfilled jobs because applicants cannot pass drug tests.The impact of this epidemic on our economy is devastating, and continued, sustainable Medicaid funding for addiction treatment services is needed to get people back into the workforce.

Cutting Medicaid by close to $840 billion and capping federal contributions going forward will undoubtedly have a devastating effect on patients, families and communities grappling with opioid addiction. We can’t pretend that a few billion dollars in grant funding will fill the huge gaps in our healthcare system left by reducing Medicaid funding. We must maintain a Medicaid financing structure that ensures our patients can access addiction treatment. Their lives depend on it.

Kelly J. Clark, MD, MBA, DFASAM, is the president of the American Society of Addiction Medicine.

The views expressed by contributors are their own and are not the views of The Hill.

Tags Health care in the United States Healthcare reform in the United States Medicaid Mental health Opioid use disorder Substance dependence

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