Waiver allows state to continue drug treatments through Medicaid

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The Washington State Health Care Authority (HCA) has announced the final federal approval of an amendment to the state’s Medicaid Transformation waiver, ensuring the state can continue treating substance use disorders in the most appropriate way.

The Centers for Medicare & Medicaid Services (CMS) approved HCA’s request to receive federal Medicaid funding for services provided to Apple Health (Medicaid) clients to treat opioid addiction and other substance use disorders when those services are offered in facilities called institutions for mental disease (IMD).

Federal rules restrict the use of Medicaid funds for treatment in IMDs, defined as facilities larger than 16 beds and primarily engaging in the treatment of mental health or substance use disorders. Several inpatient and mental health and residential facilities in Washington are considered IMDs, and approval of this amendment allows the state to maintain and expand access to inpatient and residential treatment.

The amendment applies to Washington’s existing Section 1115 waiver, known as the Healthier Washington Medicaid Transformation. The five-year effort launched in January 2017 and provides up to $1.1 billion of incentives for rewarding high-quality care. It takes a patient-centered, holistic approach to care, creates partnerships among community organizations, and adds support systems for older adults, people with chronic homelessness and joblessness, and family caregivers.

“This amendment to Washington’s Medicaid Transformation effort will help save lives,” said MaryAnne Lindeblad, HCA’s Medicaid director. “Improving the health of our populations through better substance use disorder treatment is fundamental to improving the social well-being of our citizens. This enables us to provide even more support to all areas of the state to improve care and ensure the right services reach all of our communities.”

“I congratulate Governor Inslee and his team for crafting a comprehensive strategy that will improve health outcomes for Medicaid beneficiaries by increasing access to high quality care to combat substance use abuse,” said CMS Administrator Seema Verma. “Washington is the 11th state in the last nine months to gain federal approval for this important tool in the fight against the opioid crisis.”

Additionally, CMS approved the state’s substance use disorder implementation plan protocol, which outlines Washington’s path to provide care for Medicaid beneficiaries with opioid use disorder and other substance use disorders. The implementation plan describes the requirements and milestones that the state will follow in order to accomplish the goals of the amendment. Other technical corrections to existing special terms and conditions were also included in the approval.

Medicaid Transformation is a collaborative effort to streamline the health care system. HCA designed the effort with input from health care leaders, providers, community advocacy groups, public health representatives, and citizens, among others.

Locally led efforts will engage and support clients, providers, and communities through:

  • Delivery system transformation strategies led by regional Accountable Communities of Health.
  • A broader array of service options to enable older adults and individuals with disabilities to stay at home and delay or avoid need for more intensive care.
  • Housing and employment supports for Apple Health clients with the most critical needs.

For more information about Medicaid Transformation, visit www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation.

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