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More Virginians are able to afford to get help in dealing with substance abuse disorders, and the state has the resources to care for them, according to recent studies at Virginia Commonwealth University.
An expansion of Medicaid coverage earlier this year, combined with state programs to limit access to opioid prescriptions, and a boost in addiction treatment programs through the state’s Addiction and Recovery Treatment Services (ARTS) leaves Virginia well-positioned to help its previously uninsured residents who are dealing with addictions, according to Peter Cunningham, a professor in the Department of Health Behavior and Policy in the VCU School of Medicine. He’s a co-leader with the school’s Andrew Barnes of a five-year evaluation of the ARTS program.
About 400,000 lower-income Virginians became eligible for health coverage through Medicaid in January. About 233,000 state residents now have coverage through the program. ARTS, which began in 2017, offers a full range of treatment, including detox, short-term residential care, outpatient programs and medication-assisted treatment.
VCU researchers determined that 100,000 uninsured state residents self-reported alcohol or drug abuse or dependence. That represents 17 percent of all uninsured residents. Of those, researchers estimate, up to 60,000, including 18,000 with opioid use disorders, could have access to treatment through ARTS’s more than 440 care-providing groups.
“We do expect a fairly large increase in demand for addiction treatment,” Cunningham said. VCU notes that increased access could mean less demand on hospital-based services. Uninsured people seeking help with substance abuse issues accounted for 33 percent of hospital admissions in Virginia in 2016. In Central Virginia, which includes metro Richmond, 41 percent of uninsured admissions to hospitals stem from substance use disorders. VCU reports that 34 percent of the uninsured in the area are likely eligible for coverage under the Medicaid expansion.
The greatest potential demand for substance use disorder treatment may be seen in West Central Virginia, around Lynchburg and Roanoke (at 40 percent), and in the Southwest (43 percent) and Southside Virginia (46 percent), according to the projections. That’s based on higher rates of eligibility for care through the Medicaid expansion and on high rates of hospital admissions for substance use disorder treatment by people who are uninsured in those areas.
VCU also reports that state restrictions on opioid prescriptions are having an impact. The number of Virginians covered through Medicaid who had opioid prescriptions have dropped from 83,000 in 2012 to 42,985 last year. Also, the time frame for opioid prescriptions has dropped by 66 percent, from 335.5 days per 100 Medicaid recipients in 2012 to 114.7 days per 100 in 2018.
The prescription numbers are important because of the link between high prescribing rates and increases in overdose deaths, and because the more pills prescribed and the longer the use, the greater risk of developing addictions and overdosing, according to the report.
People who are receiving opioid prescriptions are also receiving prescriptions for naloxone, a medication that can reverse an overdose. About 1,000 Virginians with Medicaid coverage who received an opioid prescription in the first three months of 2018 also received a naloxone prescription. There were none in the first quarter of 2016.
Cunningham notes those findings are in line with national trends: Opioid prescribing peaked in 2012 and has been in decline. He noted there had been concerns that increased enrollment through Medicaid could lead to greater access to opioids and an increase in the number of addictions, but studies in some of the other 32 states that have gone through Medicaid expansion prove otherwise; that instead of an increase in addiction, there is an increase in the number of people in treatment. Medication-assisted treatment, considered the standard of care in substance use treatment, increases by 70 percent, according to VCU.
ARTS paid competitive rates to providers, and in turn saw a 173 percent increase in provider numbers. The number of Medicaid members in Virginia receiving substance use disorder treatment doubled, to 27,300 in 15 months.
“The impact we can have on people’s lives is enormous,” says Jennifer Lee, director of the Virginia Department of Medical Assistance Services, which administers Medicaid in the commonwealth.
Lee says that Medicaid expansion enrollment continues. The state projects a total enrollment of 360,000 through the first year.
Virginia’s Medicaid expansion includes work requirements, which the state continues to negotiate with the federal Centers for Medicare and Medicaid Services. Public hearings on the state’s waiver application ended in January. The requirements can’t be implemented until approved.
ARTS has been a boon to the uninsured and the underinsured, according to James Thompson, founder and CEO of the Virginia Center for Addiction Medicine in Richmond. He notes groups that may benefit from Medicaid expansion include new mothers who previously faced loss of benefits after birth, and poor younger men who were mostly ineligible unless they were severely mentally ill or physically handicapped.
“It’s life-saving for them,” he says.