Medicaid expansion significantly impacts substance abuse treatment services

Jan. 02--Treatment services for substance abuse increased by 740 percent for Medicaid expansion beneficiaries over the 30 months beginning in 2014, according to a report released this week by the Foundation for a Healthy Kentucky.

Medicaid was expanded that year under President Barack Obama's Affordable Care Act, and it provided for about 11,000 substance abuse treatment services midway through 2016, up by more than 10,000 compared to the first quarter of 2014.

The report suggests that expanded Medicaid eligibility in Kentucky and other elements of the health law have helped increase access to substance abuse treatment. The data is the latest in a series on expanded Medicaid services, particularly crucial in light of recent threats at both the state and national levels to scale back elements of the law or even repeal it altogether.

Foundation officials say the rising rates of prescription opioid and heroin abuse are also likely to have played a role in the growth of several types of treatments in the commonwealth. Gov. Matt Bevin's 1115 Medicaid waiver, now awaiting approval before federal regulators, outlines its own expanded treatment options.

"ACA provisions that allowed Medicaid expansion in Kentucky and required most health insurance plans to cover substance use treatment are helping ensure that more people with drug and alcohol disorders have access to the treatment they need," said foundation President and CEO Ben Chandler. "But expanded access to treatment is just one part of the solution to the growing problem of opioid abuse in Kentucky and across the nation."

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Kentucky is one of the hardest-hit states in a sweeping drug epidemic. Overall inpatient admissions for substance abuse last year were down from 2005, but the percentage of those admissions that were related to opioid use nearly doubled.

Chandler was the state's attorney general when the opioid problem in Kentucky arose in the eastern part of the state almost 20 years ago, and he said he's watched its devastating effect spread.

He helped found the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system in 1999 that eventually grew into a voluntary national program. Then, he said, opioid abuse was seen largely as a crime, because people were shopping doctors or pharmacies to turn painkillers into personal profit. When law enforcement cracked down on the flagrant use of prescriptions, however, users turned to heroin to get their fixes, and the number of overdoses skyrocketed.

"We're in a crisis," he said. "We have to stop treating this as much as a crime as a sickness."

According to the Kentucky Office of Drug Control Policy, 67 Kentucky counties had overdose death rates of more than 20 per 100,000 people in 2015, up 64 counties in 2014. Just nine counties nationwide had overdose rates that high in 2000. While prescriptions for hydrocodone, the most commonly prescribed opioid painkiller, are declining in the commonwealth, the state is now seeing an increase in deaths related to heroin. Last week, the Centers for Disease Control and Prevention released data for 2015, which showed that heroin related deaths increased 20 percent nationwide over 2014.

Chandler said the state deserves recognition for its response to the problem, but more needs to be done. He said he doesn't support any measure that would remove insurance benefits from individuals who could otherwise not seek treatment.

Austin Ramsey, 270-691-7302, [email protected], Twitter: @austinrramsey

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