The Latest Research, Commentary, And News From Health Affairs
Monday, February 22, 2021
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As part of the original Medicaid legislation, the Institutions for Mental Diseases exclusion prohibited Medicaid from covering behavioral health services for many enrollees residing in residential treatment facilities.
Thanks in part to the ACA, Medicaid has since grown into an important source of payment for behavioral health services, including substance use disorder (SUD) treatment. A major breakthrough came in 2015 when the Centers for
Medicare and Medicaid Services provided a streamlined approval process for granting state Medicaid waivers to help SUD care delivery.
After adopting these waivers, states saw significant increases in acceptance of Medicaid coverage at residential treatment facilities, according to a study by Johanna Catherine Maclean and coauthors in the February issue of Health Affairs. Interestingly, intensive outpatient treatment facilities’ acceptance of Medicaid and residential facilities’ acceptance of private insurance and non-Medicaid public insurance programs also increased in states that adopted
Medicaid waivers.
Notably, the behavioral health waiver—one of several Section 1115 Medicaid waivers—has been approved at a higher rate than all other current waivers.
While Medicaid waivers such as these can offer low-income people access to much-needed health care, many still receive unequal treatment, especially people of color. Our Elevating Voices series during Black History Month continues with a powerful narrative by physician Vanessa Grubbs about racism in kidney transplants. Her African American partner’s wait for a kidney "mirrors the fact that the median wait time for cadaveric (deceased donor) kidneys is nearly twice as long for blacks as for whites," Grubbs explains.
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