NC Budget and Tax Center, Trump Administration

Medicaid is the single largest source of care for Americans with mental health, substance abuse disorders

The N.C. House and Senate have voted through their joint budget and it does not strengthen Medicaid nor call for its expansion to help the most vulnerable North Carolinians. At the same time, the closely guarded U.S. Senate health care bill written entirely behind closed doors is finally out and it too does not strengthen Medicaid, but rather proposes deep cuts to the program. By refusing to strengthen Medicaid for North Carolinians and Americans in need of medical assistance, the approach of our General Assembly and Congress reflects not only a lack of leadership but also lack of desire to combat our nation’s opioid addiction epidemic.

Evidence shows that Americans with mental health and substance abuse disorders are the single largest beneficiaries of Medicaid expansion. Based on NC’s growing opioid crisis – an average of 4 deaths a day – the intersection between Medicaid and opioids is very relevant. According to the National Council for Behavioral Health:

  • Medicaid is a vital source of care for people living with mental illness or addiction: In 2014, spending by Medicaid accounted for 25 percent of all mental health spending in the U.S. and 21 percent of all substance use disorder expenditures in the nation. Approximately 29 percent of persons who receive health insurance coverage through the Medicaid expansion either have a mental disorder (e.g. schizophrenia, bipolar disorder, clinical depression, anxiety) or a substance use disorder (e.g. alcoholism, opioid addiction) or both.
  • Medicaid expansion is an opioid treatment program: As drug overdoses have overtaken auto accidents as one of the leading causes of preventable death in the U.S., states have turned to medication-assisted treatment (e.g., Vivitrol, Suboxone, Buprenorphine, and the overdose reversal drug Naloxone) as an important tool in combatting the opioid epidemic. Many states with the highest opioid overdose death rates have used Medicaid to expand access to medication–assisted treatment; for example, in Kentucky, Maine, Pennsylvania, Ohio and West Virginia, Medicaid pays for between 35 and 50 percent of all medication-assisted treatment.

Given these facts, it is unfortunate that the General Assembly’s joint budget, instead of strengthening Medicaid and addressing issues in a comprehensive manner, has simply chosen to allocate $500,000 each of the next two years for a medication-assisted opioid use disorder treatment pilot program.

Given the General Assembly’s lack of interest in strengthening Medicaid to help North Carolinians in need, it is worth noting that President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis held its first meeting last Friday and Medicaid was the elephant in the room.

President Trump appointed Governor Cooper as one of his five commission members to combat the opioid crisis, and Cooper used his allotted time to tie the fate of the American Health Care Act—and the fate of Medicaid—to the future of the opioid crisis, stating:

“At the addiction level we need treatment and prevention … and we’re kidding ourselves if we don’t think that what is happening over in Congress regarding issues of health care, matters to this issue. … If we make it harder and more expensive for people to get health care coverage, it’s going to make this crisis worse.”

Overall, it is critical for legislators to understand that Medicaid is the single largest source of care for Americans with mental health and substance abuse disorders. Given the opioid crisis in North Carolina, legislators must do more to strengthen Medicaid. Cutting Medicaid and reducing access to it will only worsen the opioid crisis that the people of our state are facing.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

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