Friday, May 25, 2018
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Expanding treatment

Congress should change an outdated law that is hindering states in their battle against addiction

Ohio’s heroin and opioid epidemic has finally grabbed the attention of Congress. A recently introduced bill would expand treatment by changing an outdated law that restricts the use of Medicaid dollars to respond to addiction.

The 1965 law bans Medicaid reimbursements to hospitals and other medical providers that have more than 16 beds. The provision — called the Institution for Mental Diseases (IMD) exclusion — probably made sense when Congress created Medicaid. Fifty years ago, the federal government aimed to discourage the warehousing of mentally ill patients.

Today most states have a different problem: too few inpatient beds for severely mentally ill people. Moreover, the 16-bed cap also applies to drug treatment. As such, it has hindered states in their battle against the epidemic of addiction to heroin and opioid-based prescription painkillers.

The rule has contributed to waiting lists, typically amounting to dozens of people, for residential treatment across Ohio. Such delays discourage addicts from getting treatment and inevitably lead to more fatal drug overdoses, now Ohio’s leading cause of accidental death.

The proposed legislation would create a five-year demonstration project that would include as many as 10 states. Those states could lift the Medicaid bed cap for drug abusers, though the cap would still apply to mental-health services.

Treatment providers have been unable to expand their 16-bed inpatient treatment centers, despite a growing need for residential care for addiction. Such treatment, with all the support it provides for one to three months, is especially important to some people in early recovery.

“If they don’t have the environment to stabilize, start the recovery process, and stay away from outside influences, the risks of relapse and overdose go up,” James Schultz, director of adult drug and alcohol services for the Zepf Center in Toledo, told The Blade’s editorial page.

The Breaking Addiction Act of 2014 — introduced by two Ohio Democrats in the U.S. House, Reps. Marcia Fudge of Warrensville Heights and Tim Ryan of Niles — would launch a pilot program that would enable states to get federal reimbursement for Medicaid services that treat substance abuse at a community treatment center of more than 16 beds.

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Expanding Medicaid-eligible services in 10 states is estimated to cost $60 million a year. Getting more drug-addicted people into recovery and on their way to productive lives, however, should save far more in overall government spending, including law enforcement.

The legislation also prudently orders the federal government to evaluate and report the results of the pilot program, including its effects on costs, access to care, readmissions, and emergency care.

So far, the bill lacks the bipartisan support it needs to clear the House. That’s more than unfortunate. Partisan politics has no place in the fight against addiction. Congress could take a lesson from the Ohio General Assembly, which this year has enacted four bipartisan laws aimed at the state’s opiate epidemic.

Fatal heroin-related overdoses in Ohio have tripled in the past three years to more than 1,000 a year. An estimated 200,000 Ohioans are addicted to opioids.

Members of Congress should not delay in approving a simple and inexpensive change that would help states fight this insidious epidemic. That means passing the Breaking Addiction Act now.

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