Bill Overview
Title: Medicaid Coverage for Addiction Recovery Expansion Act
Description: This bill allows state Medicaid programs to cover residential addiction treatment facility services for adults between the ages of 22 and 64 if such services are offered as part of a full continuum of evidence-based treatment services. Residential addiction treatment facility services are medically necessary inpatient services provided in an accredited, size-limited facility for the purpose of treating a substance-use disorder within a specified time period. In addition, the bill establishes a grant program for states to expand infrastructure and treatment capabilities of existing youth addiction treatment facilities that (1) provide addiction treatment services to youths under Medicaid or the Children's Health Insurance Program (CHIP), and (2) are located in communities with high numbers of medically underserved populations of at-risk youths. At least 15% of grant funds awarded to a state must be used for making payments to rural facilities.
Sponsors: Rep. Foster, Bill [D-IL-11]
Target Audience
Population: People with substance use disorders needing Medicaid-covered treatment, ages 22-64, plus eligible youth
Estimated Size: 24000000
- The bill targets adults between the ages of 22 and 64 who require residential addiction treatment and are covered by Medicaid.
- According to the National Survey on Drug Use and Health (NSDUH), approximately 23.5 million Americans aged 12 and older suffered from substance use disorders in 2020.
- Medicaid covers around 20% of Americans, which translates to roughly 64 million individuals in 2023. Assuming a proportion of these are adults aged 22-64 with substance use disorder is appropriate.
- In addition to adults, the population of youths who require addiction treatment and are covered by Medicaid or CHIP will also be impacted.
- Specific estimates for the number of youths needing addiction treatments are less clear due to the varying definitions of 'at-risk' but are included in the broader health-focused studies.
Reasoning
- The policy targets a significant number of Americans, particularly those within the specific age group and with substance use disorders. It aims to enhance access to residential treatment centers, which are critical for effective recovery.
- Given the number of Medicaid beneficiaries and the prevalence of substance use disorders, the policy is likely to create positive impacts on well-being for a subset of this population, while many others may remain unaffected due to geographic, demographic, or personal factors.
- Incorporating improvements in youth treatment facilities can have a long-term positive effect on medically underserved populations by preventing the progression of addiction from a young age.
- Cost limitations mean the policy may not cover all who need treatment, especially in the first few years. However, targeting the highest-need areas and facilities ensures efficient use of resources.
- The baseline number of Medicaid beneficiaries with substance use disorders suggests a significant potential impact population, but access and distribution limitations will determine the real extent.
Simulated Interviews
Unemployed (West Virginia)
Age: 38 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- The expansion of Medicaid coverage for treatment is crucial.
- I struggle to stay clean without inpatient support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 2 |
| Year 20 | 8 | 2 |
Retail worker (Texas)
Age: 25 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I'm concerned about youth addiction in my community.
- The grant program sounds like it will make a difference.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Tech support (New York)
Age: 31 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I've done well with outpatient, but some friends need more help.
- Residential facilities could prevent relapses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Student (California)
Age: 29 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 14/20
Statement of Opinion:
- It's supportive seeing recovery options improve for those in need.
- Treatment centers play an essential role.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
Retired (Florida)
Age: 63 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- Not impacted personally, but hopeful for impacted communities.
- Empowering treatment centers might ease local issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Manufacturing worker (Kentucky)
Age: 45 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- My kids' access to services is just as crucial as mine.
- This policy could change lives, including mine.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
Carpenter (Oregon)
Age: 52 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- Fully supportive of broader access to treatment services.
- I volunteer because community support matters.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Teacher (Illinois)
Age: 41 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 11/20
Statement of Opinion:
- Increasing treatment accessibility can substantially help youth on the edge.
- The grants are essential for prevention.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Uber driver (Ohio)
Age: 23 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- It's reassuring knowing Medicaid might cover inpatient services if needed.
- I hope this helps those who are worse off.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
Social worker (New Mexico)
Age: 55 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- I've advocated for more comprehensive Medicaid coverage, so this is encouraging.
- Infrastructure is as necessary as treatment options.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 6 |
Cost Estimates
Year 1: $5000000000 (Low: $4000000000, High: $6000000000)
Year 2: $5200000000 (Low: $4200000000, High: $6200000000)
Year 3: $5400000000 (Low: $4400000000, High: $6400000000)
Year 5: $5800000000 (Low: $4800000000, High: $6800000000)
Year 10: $7000000000 (Low: $6000000000, High: $8000000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- High upfront costs associated with expanding both adult Medicaid treatment and youth facility infrastructure.
- Potential for significant long-term savings and public health benefits if successful.
- Need to address regional disparities, particularly rural access and treatment availability.