Last fall, West Virginia got its Medicaid 1115 waiver approved, allowing, among other things, Medicaid to pay for treatment in opioid treatment programs (OTPs). The state’s decade-old moratorium against any new OTPs still exists, however, and state officials don’t expect that to go away, even though the addition of Medicaid reimbursement will probably make treatment demand surge.
West Virginia is hard hit by the opioid epidemic. Cindy Beane, commissioner of the state’s Bureau for Medical Services in the Department of Health and Human Resources, said there are no plans to eliminate the moratorium.
Waiver Grants Additional Initiatives
Other initiatives granted by the waiver: payment for peer recovery services, and payment for residential treatment in programs with more than 16 beds. There is actually no need for a waiver for Medicaid to pay for treatment in an OTP; the Center for Medicare and Medicaid Services has no rule against it. This was a state decision by West Virginia, first to ban Medicaid payment for OTPs, and now to allow it.
“I commend the state for taking this step forward and getting methadone covered under Medicaid,” said Peter Morris, division president for Acadia Healthcare, which operates seven of the nine OTPs in West Virginia.
Morris does expect the demand for treatment to increase due to Medicaid, but the programs can’t create new facilities because of the moratorium. And he is sure there is already pent-up demand.
New Sites
A lifelong resident of Rhode Island, where he was with Discovery House before joining Acadia almost three years ago, Mr. Morris said that his former state has about 5,000 patients out of a total population of about 1 million people. West Virginia’s population is almost twice that size, but is only treating 5,500 patients, of whom 4,900 are in Acadia OTPs. So he knows that there are thousands of patients who need treatment and aren’t getting it. In addition, West Virginia is much larger geographically than Rhode Island, meaning that patients have to travel an hour or more in some cases to get to treatment in West Virginia.
“There’s definitely a demand for more sites in West Virginia, just from a population-based standpoint,” said Mr. Morris, who is based at Acadia headquarters in Tennessee. “We have patients driving long distances to get to our clinics.”
In other states, when a facility gets too big, Acadia would try to locate a new facility in an area that would be convenient for many patients, said Mr. Morris. For example, if there are 1,000 patients in one program, and 200 live in a zip code that’s 45 minutes away, that would be a good zip code for a new OTP, said Mr. Morris. “With the moratorium, we can’t use that strategy in West Virginia.”
How many patients could the existing Acadia OTPs add? “It’s hard to tell without having a crystal ball,” said Mr. Morris. “We have a couple of smaller programs, other clinics with 800 patients, a couple with 1,000.” Adding many more patients “could lead to fiscal constraints,” he said. “Very broadly, we could not treat another 4,900 patients—maybe a couple thousand.”
Converting to Medicaid
Of the 4,900 patients currently in treatment, about 50% would convert from self-pay to Medicaid, based on Acadia’s experience elsewhere in the country, said Mr. Morris. When Indiana started taking Medicaid in September, about half of the patients converted, he added.
Medicaid rates have not been finalized, but Mr. Morris expects the bundled rate in West Virginia to be about $105 per week. This is good news, he said. “The focus over the last 12 months has been getting Medicaid coverage.”