Faced with 20 states that haven’t expanded their Medicaid programs, the federal government is trying to tie expansion to getting more residents mental health and substance abuse treatment.
A government report released Monday stressed that nearly 2 million uninsured, low-income people with a substance abuse disorder or mental illness live in states that haven’t expanded Medicaid under the Affordable Care Act.
The report from the Department of Health and Human Services looks at a collection of studies and data on behavioral health and research on the Medicaid expansion. Thirty states and the District of Columbia have expanded Medicaid.
It projects that if the remaining holdouts expanded the program, 371,000 fewer people would experience depression symptoms. The report makes that claim based on “experimental research on the effects of Medicaid coverage.”
Administration officials also said the program could help to address substance abuse disorders such as opioid abuse, which kills about 52 people every day, according to federal figures.
“By expanding Medicaid, you have an important new opportunity to fund a bunch of the most important tools dealing with that,” said Richard Frank, assistant secretary for planning and evaluation for HHS, in a Monday call with reporters.
Whether the push will make any dent is an open question. A majority of the holdouts are Republican-led states that are vehemently opposed to Obamacare and the expansion.
States are also worried about the long-term economic consequences of the expansion. The Obama administration will pay for the full cost of the expansion for three years, but then will expect the states to kick in a small amount after that.
Frank said that getting people treatment for mental health can increase productivity, which can help to allay financial concerns.
“Substance use disorder treatment was associated with $5,366 annually in employer savings from reduced absenteeism alone,” the report said. “The overall economic benefit, including reduced absenteeism, improved productivity and reduced conflict, was $8,205 annually per worker with substance use disorder.”
Congress is searching for ways to tackle the opioid crisis. A major bill was approved in the Senate last month and now awaits action in the House.
The White House also has made a big push to address opioid and heroin abuse.
“As we talk to states both on the Republican side and the Democratic side, behavioral health inevitably comes up as a talk of discussion,” Frank said. “We thought it was a good time to inject some new facts into that discussion.”
The administration has made progress with some red states by agreeing to changes in the program via a waiver. For instance, some states such as Montana have added cost-sharing requirements for certain beneficiaries.
Such concessions were key to getting the expansion through the conservative state last year.
