Tackling the Substance Use Disorder Epidemic

By Jennifer Ryan
Vice President, Harbage Consulting

Last week, West Virginia submitted its first Medicaid section 1115 waiver request – a proposal designed to address the state’s opioid addiction crisis. Developed with support from Harbage Consulting, West Virginia’s waiver application is an important step toward gaining federal financial support and technical assistance to build a continuum of care, promote access to substance use disorder (SUD) treatment, and support long-term recovery.

The state’s waiver proposal is available on the Department of Health and Human Resources website. The waiver application is also posted for public comment on Medicaid.gov.

Opioid addiction is a serious national public health issue. It affects people from all socio-economic statuses, all races and education levels and has become a public health crisis in nearly every state in the nation. Since 2000, the rate of deaths from drug overdoses has increased by 137%; the rate of overdose deaths involving opioids (opioid pain relievers and heroin) increased by 200%. We are proud that Harbage Consulting has had the opportunity to support two states – West Virginia and California – in tackling the substance use disorder (SUD) epidemic.


West Virginia has the dubious distinction of leading the nation in the rate of overdose deaths and the number of babies born exposed to substance use – a condition known as Neonatal Abstinence Syndrome (NAS). The Medicaid waiver opportunity gives the state a pathway to build upon and coordinate existing efforts to address these challenges in a concrete way. If the waiver is approved, West Virginia will be working to:

  • Increase the number and location of SUD providers across the state;
  • Provide Medicaid coverage of residential SUD treatment;
  • Adopt additional Medication Assisted Treatment (MAT) strategies through coverage of methadone and broad distribution of naloxone (which can be used by lay people to reverse the effects of an overdose); and
  • Invest in strategies like recovery coaching and supportive housing arrangements that are designed to sustain recovery.

Harbage Consulting has also been working for several years with the California Department of Health Care Services, the first state to receive a Medicaid section 1115 waiver for SUD treatment. Known as the “Drug Medi-Cal Organized Delivery System,” California’s program is now in the implementation stages. California is working closely with counties and CMS to address policy and program issues around network adequacy, access, quality assurance, and other critical beneficiary protections.

Working in these two vastly different states has underscored the significance of the SUD issue and the common challenges states face. Addressing these challenges in a comprehensive way that will change outcomes can be daunting. States will need to pursue multiple strategies and employ a coordinated approach to stemming the supply of opioids, ensuring that robust prevention and treatment options are available, and ensuring that the necessary supports are in place to sustain long-term recovery. The opportunity to use the Medicaid program as a catalyst to treating SUDs is important for all states to consider.

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