Medicaid work requirements may worsen opioid crisis, says letter from 160 organizations

CMS's recent decision to allow states to deny Medicaid benefits to people who do not fulfill a work requirement may prevent patients with substance use disorders from receiving treatment, according to a letter to the Trump administration signed by 160 groups.

Here are six things to know:

1. The letter states although work requirements are intended for people eligible for Medicaid on a basis other than disability, many individuals with chronic illness and disability would still remain subject to work requirements.

2. The work requirement exemption for people with disabilities would not protect those whose health condition prevents them from working. Individuals may be unable to qualify for Medicaid because they do not have documentation of disability, but cannot get their disability documented because they do not have health coverage, according to the letter.

3. For individuals with a substance use disorder, having healthcare coverage can improve access to including medication-assisted treatment, which reduces overdose risk and other drug-related harm. At present, Medicaid covers three out of every 10 individuals with opioid use disorder and provides substance use disorder treatment services and medications.

4. While CMS’s guidance directs states to take steps that make Medicaid and substance use disorder treatment available to people diagnosed with a substance use disorder, CMS does not bind states to specific requirements for ensuring compliance. The CMS guidance suggests that states could chose to count time spent in certain types of substance use disorder treatment toward work requirements, but does not require states to do so.

5. The letter claims that CMS's policy will make it even more difficult for people with criminal records — nearly one in three Americans —to obtain needed physical and mental healthcare services and medications, since over 85 percent of employers conduct background checks.

6. The letter claims that CMS's Medicaid work requirements policy is at odds with bipartisan efforts to curb the opioid crisis. The letter urges CMS to withdraw the January 11 guidance and to immediately discontinue waiver approvals for state Medicaid waivers that include work requirements.

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