Medicaid May Soon Pay For Some Inpatient Addiction Treatment

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For decades, if people on Medicaid wanted to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources.

Now, in a dramatic shift, the federal government is likely to chip in, too. The agency that governs Medicaid is proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a Medicaid managed care plan.

But in Pennsylvania, those who work in the addiction field aren’t happy with that news. While it’s a good start, they say, only 15 days of residential care isn’t nearly enough time for many people addicted to heroin, opioids, alcohol or other drugs to get clean and stay that way.

“Where they came up with the 15 days, I don’t know, but it’s not based on research” says Mike Harle, head of the nonprofit treatment program Gaudenzia, which serves about 20,000 patients a year in Pennsylvania, Maryland and Delaware. In just 15 days, he says, you can’t expect to achieve a positive outcome.

“Do you know how expensive that would be, with no outcome?” Harle says. “We wouldn’t want to do it. We would not want to do it.”

Up until now, the state of Pennsylvania has used an obscure provision in the federal law to get federal reimbursement for much longer rehab stays for some people. Pennsylvania officials worry that the loophole will likely go away if the new Medicaid proposal is enacted.

In its guide to drug addiction treatment, the National Institute on Drug Abuse says:

Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length.

Dr. Jeffery Samet, a professor at Boston University’s Clinical Addiction research unit, says there’s been little funding for research that gets at the optimal length of an inpatient stay, in terms of effectiveness. And in the absence of good

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