Congress’ proposed Medicaid cuts would undo historic progress reducing overdose deaths

Provisional data shows that overdose deaths in West Virginia declined by an astonishing 43.5% in the last year. Nationally, overdose deaths fell 27% over the same period, the largest one-year decline ever. While researchers are still analyzing the data, declines in overdose deaths have coincided with increased Medicaid coverage for substance use disorder treatment, with West Virginia leading the way in using Medicaid and the federal dollars it brings into the state to address our people’s needs and improve overdose outcomes. But those gains will be stalled or even reversed if the Medicaid provisions in Congress’ reconciliation package are made law — taking away the most effective tool we have to save lives and help our people recover from tens of thousands of West Virginians. 

Medicaid funding plays a critical role in West Virginia’s efforts to treat substance use disorder and prevent overdose deaths. The Mountain State was the first in the nation to receive approval under the Trump Administration in 2017 to use flexibilities within the Medicaid program to provide substance use treatment. Now, Medicaid is the main source of health coverage for opioid use disorder, covering more than half of all adults receiving medication for opioid use disorder and two-thirds of those receiving outpatient treatment and peer support services.

The Medicaid expansion, the portion of the program that is most directly under threat in the proposal moving through Congress, has given many West Virginians who struggle with addiction their first real opportunity to access the treatment they need. Nearly three-fourths of West Virginians who receive treatment for substance use disorder are covered through the Medicaid expansion, and one study found that, even after controlling for other policies to address substance use disorder, expansion states have seen a much larger reduction in overdose deaths (9.5%) than non-expansion states. 

The Medicaid proposals currently under consideration in Congress would dramatically reduce access to treatment for those who need it most and undermine the historic progress made over the last year. 

They increase paperwork, red tape and out-of-pocket costs that will result in many adults, including those with substance use disorder, losing their health coverage. The non-partisan Congressional Budget Office estimates  more than 10 million Americans would be kicked off Medicaid if this package were enacted, with a separate analysis estimating 55,000 here in West Virginia. 

One piece, implementing work reporting requirements, would kick some adults off Medicaid if they do not submit proof showing they are working or qualify for an exemption, even though the vast majority of West Virginians do fall under one of those categories. Work requirements pose a particular challenge for adults with substance use disorder, for whom being in active treatment is often a prerequisite for them to secure work. And while the legislative proposal instructs that adults who are considered medically frail, which includes having a chronic substance use disorder, should be exempt from these requirements, proving one qualifies for an exemption is also a complex multi-step process that often results in eligible people losing coverage. Time spent on reporting compliance takes away from therapy compliance, creating a new barrier to recovery. 

Another component of the legislation would require states to impose cost-sharing on Medicaid expansion adults that could be as high as $35 per service. Research shows that co-pays cause individuals who need care to forgo it. Applying such a disincentive to ongoing treatment for individuals with chronic conditions like substance use disorder would undermine our health goals and could result in backsliding on recovery.

Each of these policies result in people losing their health coverage, not because they fail to meet the requirements, but because the new paperwork and multi-step processes are confusing, burdensome, and difficult to follow. When Arkansas implemented Medicaid work reporting requirements for a short period in 2018, one-quarter of those subject to the new requirements lost their health coverage in the first six months alone, despite the fact that researchers found nearly everyone who lost their coverage was working or should have received an exemption. Regardless, a substantial portion of the population had difficulty navigating the process so complex researchers found that, if left in place, 97% of enrollees would be deemed ineligible over time for failing to meet paperwork requirements. 

Medicaid — and the Medicaid expansion specifically — is the strongest tool in our arsenal to address substance use disorder. Over the last year, those investments have shown significant progress with the largest decline in overdose deaths in history, with West Virginia leading the way. Cuts to Medicaid like those Congress is currently considering would undermine that progress, hurt West Virginia families and cost lives.