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Stephanie Pellitt

Policy and Advocacy Associate

Breaking Addiction Act Reintroduced in Congress

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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 of 2017 would allow state Medicaid programs to cover residential addiction treatment in facilities of 16 or more beds. The bill is intended to help states build more capacity for addiction treatment as they work to address the opioid crisis.

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. The provision is known as the Institute of Mental Disease (IMD) rule. 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 of 2017, introduced by Reps. Marcia Fudge (D-OH), Tim Ryan (D-OH), Joyce Beatty (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 is reflective a nationwide trend of states requesting a waiver from the IMD rule as a part of an 1115 Medicaid waiver.

Rep. Fudge describes the how the IMD rule impacts individuals in need of care, “While many seek care, they are turned away because communities cannot meet the demand for treatment.” Rep. Fudge goes on to explain, “By getting rid of the antiquated IMD exclusion, The Breaking Addiction Act not only increases access to treatment but gives states the flexibility and resources they need to save lives”

Rep. Fudge and her colleagues first introduced the Breaking Addiction Act in the 113th Congress. The new version has been modified to allow state Medicaid plans to be amended to permit payment for residential substance use treatment in IMDs. Previous versions would have allowed states to use 1115 waivers to waive the IMD rule. Read more here.