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Despite Trump's Health-Care Changes, He's Keeping Obama's Opioid Strategy

With no end to the epidemic in sight, the feds are helping some states treat more addicts.

Trump Opioids
First lady Melania Trump listens as President Donald Trump speaks during a briefing on the opioid crisis.
(AP/Evan Vucci)
In the last two weeks, President Trump has taken several steps to reverse parts of President Obama's signature health-care law. He weakened the Affordable Care Act's birth control mandate, signed a wide-ranging executive order that, among other things, allows for more unregulated plans, and announced the end of subsidies that help low-income consumers buy insurance.

But there's at least one area of health care where the White House is continuing its predecessor's policies: those designed to aid the opioid epidemic.

The federal Centers for Medicare and Medicaid Services (CMS) approved a waiver last Tuesday for West Virginia -- one of the states affected most by the opioid epidemic -- that will help the state cover substance abuse treatment for more people. 

Medicaid, the nation's health insurance program for the poor, hasn’t been allowed to cover substance abuse treatment centers with more than 16 beds since 1965. The provision was part of a greater push away from large mental institutions, many of which were seen as sites of human rights abuses, and toward smaller community-based mental health services. But once most big mental institutions closed, many communities didn't pick up the slack, and the number of psychiatric beds available diminished.

The waiver allows the state to pay for Medicaid patients to go to 30-day residential treatment centers -- regardless of how many beds they have. 

In 2015, the Obama administration sent a letter to state Medicaid directors encouraging them to apply for these Medicaid waivers. Since then, five other states -- California, Maryland, Massachusetts, New Hampshire and Virginia -- have received them. Virginia is the only other state to get its waiver approved during the Trump administration. Illinois and New Jersey currently have pending waivers, which hopefully will get approved soon, says Peggy Bailey, director of health integration for the Center on Budget and Policy Priorities (CBPP).

“The [Trump] administration has said that both the opioid epidemic and state flexibility is a priority for them. This hits on both of those things, and that’s exactly what these waivers are supposed to do,” says Bailey. 

Giving states flexibility to help more drug addicts has particular weight in West Virginia. In 2015, it had the nation's highest rate of opioid overdose deaths, at 41 people per 100,000. Nationwide, opioids were responsible for the death of 33,000 people that year. Since 1999, the number of opioid overdose deaths has quadrupled, according to the Centers for Disease Control and Prevention. 

West Virginia's waiver was approved the same day First Lady Melania Trump visited a drug treatment center in the state.

Upon getting the waiver news from CMS, Cindy Beane, commissioner of West Virginia’s Department of Health and Human Resources Bureau for Medical Services, told the Charleston Gazette-Mail, "I had tears in my eyes."

Mattie covers all things health for Governing.

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