Should State Medicaid Programs Get Matching Federal Funds for Inpatient Opioid Abuse Treatment? (H.R. 5797)

What is H.R. 5797?

(Updated November 15, 2018)

This bill — the IMD CARE Act — would allow state Medicaid programs to receive matching federal payments for services provided by institutions for mental disease (IMDs) to treat Medicaid-eligible adults between the ages of 21 and 64 suffering from opioid use disorder for up to 30 days per year. Under current law, a policy known as the “IMD exclusion” prohibits matching payments to state Medicaid programs for most services provided by IMDs except in limited circumstances. This change would apply for fiscal years 2019 through 2023.

The bill’s full title is the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act.

Argument in favor

This commonsense bill would allow state Medicaid programs receive matching funds to treat Medicaid-eligible patients suffering from opioid addiction at institutions for mental disease.

Argument opposed

While well-intended, this bill is more rigid than the administrative workarounds state Medicaid programs can use and may limit treatment for patients suffering from other forms of addiction.

Impact

Patients in IMDs; IMDs; state Medicaid programs.

Cost of H.R. 5797

The CBO estimates that enacting this bill would increase direct spending by $991 million over the 2019-2028 period.

Additional Info

In-Depth: Sponsoring Rep. Mimi Walters (R-CA) introduced this bill to expand treatment options for Medicaid recipients who are suffering from opioid addiction:

“Combatting America’s opioid epidemic means ensuring those battling addiction have ready access to quality treatment. Unfortunately, current law prevents some Medicaid recipients battling opioid addiction from receiving the treatment they need to reclaim their lives. Sadly, an inability to receive proper care can be fatal. Ending the opioid crisis means providing treatment options, including inpatient care, to those seeking help. My bill, combined with the oversight study legislation I cosponsored, will move us toward our shared goal of saving lives from the scourge of opioid addiction.”

House Democrats expressed reservations about repealing the IMD exclusion in this manner, with Rep. Frank Pallone (D-NJ) saying this bill is “less flexible than the administrative options currently available to states”. He added that repealing the IMD exclusion solely for opioid use disorder “creates additional barriers and may further limit treatment options that require treatment for other substances.”

This legislation passed the House Energy and Commerce Committee on a voice vote and has the support of five cosponsors, all of whom are Republicans.

Media:

• Sponsoring Rep. Mimi Walters (R-CA) Press Release
  
• Committee Report
  
• CBO Cost Estimate
  
• KTVZ