West Virginia Medicaid for Substance Use Disorders

In the state of West Virginia, Medicaid health insurance is accepted at certain drug and alcohol treatment centers located throughout the state. Within the state, Mountain Health Choices provides Medicaid health insurance for people in the state who are eligible. Typically, individuals who apply for Medicaid are in a lower-income bracket or may be elderly or someone who has a disability. Medicaid is a free or low-cost insurance plan, and it helps cover the costs for someone who needs treatment for a substance use disorder.

Many families in West Virginia have loved ones struggling with a drug or alcohol addiction and will use Medicaid to help pay for drug and alcohol treatment. Not every rehab in WV will accept Medicaid insurance. If you are planning to use Medicaid for treatment, you can contact the treatment centers directly to find out if they will accept it.

To qualify for Medicaid, you must be:

• A resident of the state of West Virginia, a U.S. national, citizen, permanent resident, or legal alien
• In need of health care or insurance assistance
• In a low-income or very low-income financial situation
• Pregnant, a parent or relative caretaker of a dependent child(ren) under age 19
• Blind or have a disability or a family member in your household with a disability, or
• 65 years of age or older

The Medicaid program in West Virginia provides a medical card that can be used for medical care in the community doctors’ offices or an institutional setting, such as a nursing home. It allows people who can’t afford medical care the chance to have their health care needs met.

Medicare is administered through the federal government by the Center for Medicare and Medicaid Services (CMS) under the Social Security Administration. When Medicaid is used, it pays the service provider directly, although the patient may have to pay an out-of-pocket expense known as a copayment.

Medicaid Expansion for SUDs in West Virginia

In 2017, the West Virginia Department of Health and Human Resources (DHHR) Bureau for Medical Services announced a Medicaid waiver that allows West Virginia to expand substance abuse services and treatment for Medicaid members. The waiver was awarded by the CMS to help improve outcomes for those with a SUD diagnosis. It was expected to almost double the number of beneficiaries treated for substance use disorders — from around 12,000 to 22,000 people

“West Virginia is number one across the nation in overdose deaths,” says West Virginia Governor Jim Justice. “Since this waiver is funded more than 80% by the federal government, it’s critical to protect our Medicaid budget so our state can meet its federal obligation for these vital services. We need to help our people get the care they need to get their lives back on track and stop these senseless overdose deaths.”

What Is Included?

People enrolled in Medicaid in WV can receive additional addiction treatment services. There is now a statewide coverage expansion for intensive outpatient services and access to medication-assisted treatment. Individuals at risk for addiction are able to get screenings through their Medicaid coverage as well.

This waiver will add to a thorough statewide strategy to fight prescription drug abuse and opioid use disorders. It allows West Virginia to cover methadone, naloxone, peer recovery support, withdrawal management, and short-term residential services to all individuals enrolled in Medicaid.

“This is another important tool in West Virginia’s fight against substance use,” according to Cindy Beane, commissioner for DHHR’s Bureau for Medical Services. The waiver doesn’t only remove financial obstacles between treatment and much of the state’s low-income, at-risk population, but also opens the door for more federal funding for the state’s addiction services.

Three Areas of Services Now Covered through Medicaid

1. Screening, Brief Intervention, and Referral to Treatment (BIRT): Evidence-based programs that identify and help people who have substance use or mental health issues get into treatment.
2. Methadone treatment: Dispensing and supervising methadone use to manage withdrawal effects and as part of a larger plan of action.
3. Naloxone distribution: A statewide drive to make naloxone (Narcan) widely available to the public in addition to promoting its benefits in reversing opioid overdoses.

State Medicaid programs cover more than $1 billion each year to care for newborns with neonatal abstinence syndrome. NAS is a condition caused by opioid use during pregnancy. It often results in lengthy, expensive hospital stays to treat the infant’s withdrawal symptoms such as irritability, poor feeding, seizures, and respiratory concerns.

In 2018, the CMS approved a new financing method for these infants in West Virginia that may be the start of an effective, lower-cost treatment option for state Medicaid programs coping with the cost of NAS. Infants with NAS are typically treated in hospitals, in neonatal units, and special care nurseries which are very expensive. The average length of stay is 17 days, which costs about $1.5 billion each year. About 80% of these costs are covered by Medicaid.

“West Virginia is in the midst of a child welfare crisis and the prevalence of NAS is at the forefront of our issues,” said Bill Crouch, Cabinet Secretary of the DHHR. “We have seen a 46% increase in the number of children we take into custody and 84% of all child protective service cases involve drug use.”

Non-Hospital Treatment

Non-hospital environments can offer NAS treatment for infants with less severe symptoms at a lower cost — $600 compared to $2,600 in a special hospital nursery, or $4,000 in a neonatal intensive care unit. Previously, Medicaid coverage of NAS treatment has only included bundled payments to hospitals or fee-for-service payments to providers in non-hospital settings like neonatal withdrawal centers. West Virginia Medicaid now has the approval to cover a new approach. This is the approval of bundled payments for NAS services in non-hospital settings, called NAS treatment centers.

According to the Centers for Disease Control and Prevention, West Virginia had the highest rate of deaths from drug overdoses in the U.S. in 2016 — 52 per 100,000 residents. It also has one of the highest rates of NAS with 50.6 cases for every 1,000 hospital births in 2017.

Medicaid Expansion

Research is showing the Medicaid expansion is playing a large part in fighting the growing opioid epidemic. A study published in Health Affairs found that after West Virginia expanded Medicaid, the number of people diagnosed for opioid use disorder (OUD) rose and the number of people on buprenorphine (a medication for opioid addiction) went up, too.

The study concludes that the expansion helped get more people into treatment. The number of people on Medicaid who were diagnosed with OUD more than doubled between January 2014 and December 2016. The number of people on buprenorphine treatment increased by 6 times. Buprenorphine and methadone lower the mortality rate among opioid-addicted individuals by half or more and keep people in treatment better than non-medication methods.

Medicaid coverage generally offers a more inclusive bundle of behavioral health services than other insurance providers. Examples include:

• Psychiatric hospital visits
• Case management
• Day treatment
• Psychiatric evaluation and testing
• Medication management
• Individual and group therapy
• Family therapy
• Inpatient detoxification
• Methadone maintenance
• Smoking and tobacco cessation services

In addition, Medicaid helps people manage any co-occurring physical disorders such as high blood pressure, diabetes, and obesity.

Detox

Treatment for a substance use disorder, whether it is a drug or alcohol will typically begin with a detoxification phase. This is the period when your body rids itself of the toxins you have been using. Depending on how long you have been addicted and how much you used, this can take 3 days to a week.

The severity of the withdrawal symptoms can also vary. Withdrawal from certain drugs can be physically extreme and life-threatening. And withdrawal from other substances may be mild but have a dangerous psychological effect. In either case, you need a supervised medical detox with medication to help manage the symptoms.

Treatment

The treatment phase is when you really get to work at getting better. You may need one or more of the following programs:

• Residential: In a residential treatment program, you will live at the facility and have 24-hour supervision and therapy programs with your counselors.
• Partial Hospitalization: This is an intense program like a residential program but you go to a home-like environment in the evening.
• Intensive Outpatient: More intense than a regular outpatient program regarding the time spent at the facility, but you will go home at the end of the day.
• Outpatient: If you are not at medical risk, you may attend the outpatient program. You will go to the center for therapy 3 or 4 times a week and live at home.

Therapy

During your treatment, you will work with a counselor or counselors to get to the heart of what caused your addiction in the first place. Common therapies are:

• Family Therapy: When a person has an addiction, all members of the family are affected. This helps educate all parties and helps enable a solid support system.
•  Individual Therapy: During individual therapy, you will work one-to-one with a therapist to help understand your thinking and behavior.
•  Behavioral Therapies: There are several kinds of behavioral therapies commonly used. They are aimed at helping you see how thoughts affect behavior and strategies to avoid negative thinking.

Aftercare

After completing a treatment program, many people feel they aren’t ready to transition to regular life without relapsing. Aftercare may take the form of:

• Continuing therapy
• Living in a sober living facility while you get back to work and taking care of yourself.
• Support groups like Alcoholics Anonymous or Narcotics Anonymous