As Senate Begins Debate on Legislation to Combat Opioid & Heroin Abuse, Durbin & King Introduce Bill to Expand Access to Substance Abuse Treatment Under Medicaid

[WASHINGTON, D.C.] – This week, as the Senate prepares to begin debate on legislation to combat opioid and heroin abuse, U.S. Senators Dick Durbin (D-IL) and Angus King (I-ME) introduced legislation to expand access to substance abuse treatment for vulnerable, underserved populations. The Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act would modify the Medicaid Institutions for Mental Disease (IMD) Exclusion policy – a decades-old policy that restricts Medicaid coverage of services provided by facilities that specialize in mental health and substance abuse treatment. As a result, the policy has had the unintended consequence of limiting addiction treatment for at-risk populations.


“This week, the Senate will begin debate on legislation to combat opioid and heroin abuse. One of the issues at the heart of this fight is access to treatment. We know that by better treating people suffering from addiction – rather than arresting them or turning them away from help – we can reduce crime, improve health, and save lives. But as the result of a decades-old policy based on an outdated understanding of addiction, far too many low-income and at-risk patients aren’t able to access the treatment they need,” Durbin said.


“For people fighting addiction, an available bed in a treatment facility can mean the difference between life and death. But today, federal rules enacted more than fifty years ago are standing in the way of Maine people receiving the potentially lifesaving treatment they need,” King said. “The legislation we are introducing today will increase that cap and allow otherwise limited treatment facilities across the country to extend a helping hand to more people, and hopefully, save more lives.”


The IMD Exclusion currently prohibits the use of federal Medicaid financing for care provided to most patients in residential mental health and substance use disorder residential treatment facilities that have more than 16 beds. Illinois has 585 residential addiction treatment beds across 15 facilities that are larger than the 16-bed threshold and thus ineligible for Medicaid payments.


Under the Medicaid CARE Act, residential addiction treatment facilities would qualify for Medicaid payments if they:


  • Provide substance use disorder treatment services;
  • Are accredited by a national agency;
  • Have fewer than 40 beds; and
  • Provide services to adults for up to 60 consecutive days.


In addition, the bill would increase flexibility for pregnant and postpartum women who are seeking treatment, and would allow them to access the services they need to ensure positive birth outcomes. The legislation also establishes a new $50 million youth grant program to fund inpatient substance abuse treatment to Medicaid beneficiaries younger than 21 in underserved, high-risk and rural communities.


Durbin and King are introducing the Medicaid CARE Act as the Senate begins debate on the Comprehensive Addiction and Recovery Act. The Comprehensive Addiction and Recovery Act – which was passed unanimously out of the Senate Judiciary Committee earlier this month and which Senators Durbin and King are cosponsoring – provides for a community-based response to heroin and opioid addiction that that involves law enforcement, the criminal justice system, the public health system and the recovery support community. More information is available here.


Since 1999, the number of drug overdose deaths in the United States has more than doubled, and in most states the number now exceeds the number of traffic-related deaths. Drug overdose deaths are now the leading cause of preventable injury death, resulting in nearly 44,000 deaths each year, with most involving either prescription opioids or heroin. In Illinois, there were 1,652 overdose deaths in 2014 – an increase of nearly 29 percent since 2010. In Maine, the overall number of drug overdose deaths last year was projected to exceed the previous year, when 208 people died of overdoses – the worst year on record, according to the Maine Attorney General’s Office


Durbin announced the legislation this morning at at Haymarket Center in Chicago, Illinois. Durbin was joined at the announcement by doctors from the Haymarket Center and the Gateway Foundation. The Haymarket Center is the largest substance use and mental health disorder treatment facility in Chicago. Founded in 1975, it is one of the only treatment centers in the state that offers all levels of care as defined by the American Society of Addictions Medicine. Gateway Alcohol & Drug Treatment was founded in 1968 and is the largest provider of substance abuse treatment in Illinois, with locations throughout the state.