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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Breaking Addiction Act Introduced in House

April 30, 2015 | Addictions | Comments
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Legislation to expand Medicaid patients’ access to residential substance use treatment has been introduced in the House by a group of Ohio lawmakers. The Breaking Addiction Act (H.R. 1988) would direct the Centers for Medicare and Medicaid Services (CMS) to approve state applications for Medicaid 1115 waivers to cover services in certain residential settings.

Current law prohibits Medicaid from paying for residential or inpatient services provided to individuals in facilities of more than 16 beds that are engaged primarily in treating those with mental health and substance use conditions. As a result, states cannot receive federal Medicaid funds for most residential substance use care, and patients in need are left without access to services.

The Breaking Addiction Act, introduced by Reps. Marcia Fudge (D-OH), Tim Ryan (D-OH), and Marcy Kaptur (D-OH), aims to expand American’s access to care by allowing states to pay for residential substance use care in facilities of 60 or fewer beds. The legislation comes in the wake of last year’s announcement from CMS that it would approve a limited number of Medicaid Section 1115 waivers for short-term residential substance use care. Under the Breaking Addiction Act, CMS would be required to approve all such waivers, leveraging existing policy mechanisms to further expand the availability of residential substance use treatment. Because Section 1115 waivers must demonstrate cost-neutrality, the legislation would not increase federal spending.

“Only one out of nine Americans who suffers from substance abuse gets treated.  Many of these individuals sought care, but were turned away due to a lack of treatment beds.  In 2014, 252 heroin-related deaths occurred in Cuyahoga and Summit Counties. This is unacceptable. The Breaking Addiction Act provides the means to save lives in a responsible manner and it does so without adding to the federal deficit,” said Congresswoman Fudge.

Rep. Fudge and her colleagues first introduced the Breaking Addiction Act in the 113th Congress. The new version has been modified to be cost-neutral for the federal government and to support and enhance the 1115 waiver options available to states for residential substance use care. The National Council commends the sponsors of the Breaking Addiction Act for their efforts to expand Medicaid beneficiaries’ access to substance use care, ensuring that they can access treatment in the most appropriate setting when needed. We thank Reps. Fudge, Ryan, and Kaptur for their dedication to this important issue.