Hassan: Proposed Medicaid cuts for addiction treatment will ‘set back’ fight against fentanyl

MANCHESTER, NH – U.S. Senator Maggie Hassan met with the management and clinical team of the Elliot Center for Recovery Management in Manchester to discuss how proposed Medicaid budget cuts will negatively affect patient care.

The center is an outpatient clinic that provides treatment for substance abuse disorder. They serve a patient population that is primarily Medicaid-dependent for healthcare. The clinic offers medication-assisted treatment (MAT) in combination with counseling for the treatment of opioid and alcohol use disorders

Hassan serves on the U.S. Congress Joint Economic Committee (JEC), and she discussed a minority report released on Monday about how proposals to cut Medicaid and the addiction treatment that it provides would set back efforts to combat the fentanyl crisis.

According to the report, about 1 million people receive medication treatment for opioid use disorder through Medicaid; 60 percent of these individuals access this treatment through Medicaid Expansion, part of the Affordable Care Act (ACA). In 2014, NH created the Granite Advantage program under the ACA, which provides Medicaid to 60,000 residents.

The JEC Minority report states that in New Hampshire, there are 9,838 Medicaid beneficiaries, including expansion beneficiaries with Opioid Use Disorder (OUD) receiving medication treatments. 7,609 are expansion beneficiaries, making up 77% of the treated population.

The Elliot clinical team considers this support critical to the gains made in fighting the addiction crisis. The expansion of coverage in combination with new drug therapies and clinical approaches facilitates recovery. They shared examples from their patients with the Senator to illustrate their results.

The clinic patients may also have health, social, financial, and legal issues that compound their addiction challenges. Medicaid is the only healthcare option for most people in poverty and with low incomes. Annette Escalante, the Director of Substance Abuse Services, described the progress that is in jeopardy if changes are made to funding

“When medication was introduced, it shifted and changed our dynamics. The way that we have so many new treatments has been a blessing. Because then we were able to have those resources for folks. One of the biggest issues, though, continues to be affordability. If they don’t have medication, they won’t be able to do that. It’s certainly a domino effect. And I think that’s what’s going to happen, it’s a house of cards. It’s just going to come down,” she said.

“A small change in the overall funding could wipe out the Medicaid expansion program and obviously make it much harder for people to have access to medication-assisted treatment,” said Hassan.

Hassan also discussed the National Security implications of reducing treatment, saying, “The Trump administration has put out an intelligence report from the intelligence community. The acting director of the DEA has said how important medication-assisted treatment is to the fight against the fentanyl epidemic. Their national drug policy office has said that a critical tool in making America more secure is to make sure we have medication-assisted treatment. They see the fentanyl crisis as a security risk, and all of these national security folks have said that one of the things we have to continue to work on is reducing the demand for fentanyl in this country.”

Medicaid in New Hampshire provides healthcare coverage for 183,000 low-income residents. Medicaid covers the medical cost for 2 out of every 3 nursing home residents. Medicaid in NH costs $2.5 billion, with $1.4 billion of funding coming from the federal government. 90% of the expansion is paid by the feds.

In 2018, the NH legislature enacted a “trigger” law that will cut off state funding of the expansion if federal funding falls below the 90% level. With levels of reduction being negotiated, it is likely the medicaid expansion program in the state will

“When the Congressional Republicans in the Trump administration talk about cutting Medicaid by about a third, that implies that they’re going to cut Medicaid expansion, their contribution to below 90%. Under New Hampshire state law, that automatically cancels the program,” Hassan said, adding, “So we’re talking about thousands of people losing their coverage, and in New Hampshire, it’s I think a little bit over 7,000 people who are getting medication-assisted treatment through Medicaid expansion right now. So that’s a lot of people who suddenly don’t have access to care.”