Red States Backdoor to Cutting Medicaid for Opioid Addicts

[cduggles]

GOP Medicaid work rules imperil care for opioid abusers

Governors say they'd exempt those with drug problems but critics fear many would fall through cracks.

By Rachana Prahdan and Brianna Ehley
12/03/2017

Paul Wright shows a picture of himself in the hospital after a near fatal overdose in 2015 at the Neil Kennedy Recovery Clinic in Youngstown, Ohio, on June 15. | David Dermer/AP Photo

Red states ravaged by the opioid crisis are pushing for Medicaid work requirements that could push people out of treatment as they try to get off drugs.

Kentucky, New Hampshire, Maine and Indiana are among at least eight GOP-led states seeking federal approval to require Medicaid enrollees to work as a precondition of their health coverage. All four states have been hard hit by drug addiction, which claims 140 lives a day nationally.

Governors say they would exempt people with chronic drug problems or severe mental illness from the Medicaid work requirements, but who would qualify and under what circumstances hasn’t been spelled out. Critics fear that many addicts could lose benefits, particularly if they go in and out of treatment, or have relapsed — a not uncommon occurrence. Employers’ resistance to hiring people who have failed drug tests or have criminal records could also put health benefits at risk.

Backers of Medicaid work requirements say they're needed to reduce government dependency as the program has grown to cover more than 70 million Americans — nearly 12 million of whom obtained coverage under Obamacare.

The Trump administration is sympathetic, signaling it will sign off on the state waiver requests, even as it made combating the opioid epidemic a priority.

But even some Republican state lawmakers say they fear those with addiction issues would fall through the cracks.

“I’m all for designing programs in a way that encourages and rewards work,” said Indiana state Rep. Ed Clere, a Republican who has previously bucked party leaders. “But we have to be careful not to let that objective undermine the primary purpose of health care, which is improved outcomes and wellness. I wouldn’t want to see a work requirement get in the way of positive behavior modification and the individual’s ability to take responsibility for his or her own health.”

Indiana, which expanded Medicaid coverage to 400,000 people under then-Gov. Mike Pence in 2015, is one of the states asking for federal waivers to impose Medicaid work requirements that are primarily targeted at working-age, able-bodied adults. Officials generally are seeking to mandate 20 hours per week of work, or participation in a job-related activity, including volunteering or training.

Low-income adults in treatment for substance abuse would be exempt from the requirement, yet state data show that only slightly more than a quarter of enrollees with diagnosed problems are getting treated. Death rates stemming from drug abuse in 2015 stood at 19.5 per 100,000 residents, according to the Centers for Disease Control and Prevention.

“There’s a lot of people who don’t seek treatment who have challenges,” said Matt Brooks, president of the Indiana Council of Community Mental Health Centers and chairman of the state’s Medicaid Advisory Board. “There are folks who might need services that miss out.”

Spending on substance abuse and mental health treatment grew substantially after states expanded Medicaid coverage to low-income adults, with Medicaid spending over $7 billion on substance use disorder services in the first year of Obamacare’s expansion, in 2014, according to the Kaiser Family Foundation. The program’s spending on mental health care that year was approximately $46.5 billion.

Kentucky — whose request to impose work rules on able-bodied adults was not acted upon by the Obama administration — is expected to be the first state to receive the Trump administration’s blessing. Officials estimate that roughly 95,000 people over a five-year period would lose Medicaid benefits under Gov. Matt Bevin’s proposal, which also includes increased premiums and other restrictions.

Still, Bevin says the idea of mandating someone with addiction problems to work “doesn’t make sense.” Kentucky had the third highest rate of death due to drug overdoses in 2015, clocking in at 29.9 per 100,000 people.

“This isn’t intended to be just a one size fits all, black and white, you do it this way or you don’t get it,” he told POLITICO during a recent Republican Governors Association conference in Austin, Texas. “That’s foolish. A person like that is a true detriment to themselves, to their families and society as a whole in their addicted state. We need to get them to point where they are not in [an] addicted state so they can become an asset to themselves and their family and society.”

The state intends to exempt Medicaid enrollees from employment rules and other conservative changes if they are deemed “medically frail,” a catch-all term for people with serious conditions. Indiana includes a similar exemption.

Yet many of the details in the plans are hazy. In Kentucky, some of the qualifying conditions to be deemed “medically frail” are automatic, such as being diagnosed with HIV/AIDS, being eligible for Social Security Disability Insurance or receiving hospice care. Others — such as having a chronic substance use disorder or disabling mental health issue — would meet the definition only if they satisfy yet-to-be-determined criteria.

People with addiction issues face a number of hurdles to obtain employment, including employers that drug test their prospective employees. More than half of all employers require job candidates to take drug tests, according to a study by the Society for Human Resource Management. Relapse is also common. Nationally, the National Institute on Drug Abuse estimates that relapse rates for addiction range from 40 percent to 60 percent.

“People cannot get a job because they can’t pass a drug test,” Brooks said. “So now, not only can you not get a job because of a substance use disorder, but you’re not going to have access to health care ... and then where does that leave you?”

Criminal records for drug offenses can also make it harder to find employment. Though companies are legally prohibited from having blanket policies against hiring ex-offenders, it can be more difficult for those with a criminal history to find work.

Beyond finding work, people struggling with opioid abuse have trouble maintaining the sort of stability that enables them to hold down a job.

“This is a disease that hijacks a person’s brain,” said Mark O’Brien, vice president of state and local affairs for the Addiction Policy Forum. He added that for those in treatment programs, getting care can be time-consuming. “For some people, getting treatment is a full-time job,” he said.

New Hampshire’s waiver proposal would exempt anyone with a mental or physical illness or disability if their doctor fills out a form to verify their eligibility. People participating in the state’s drug court program are also exempt from work requirements. However, it’s unclear whether doctors would need to fill out the form only once for their patients or would routinely be required to certify that a Medicaid-eligible person still qualifies for the exemption.

“We’re not trying to leave anybody out,” said New Hampshire state Senate Majority Leader Jeb Bradley.

I will never understand people who think Trump cares about addicts.

We're flying backwards with drug policy.

 

[S.J.B.]

I will never understand people who think Trump cares about addicts.

I don't think he cares at all. I guess the bright side of that is that he's no Nixon or Reagan: drugs are definitely not one of his priorities, one way or the other.

 

[cduggles]

I don't think he cares at all. I guess the bright side of that is that he's no Nixon or Reagan: drugs are definitely not one of his priorities, one way or the other.

Unfortunately the vacuum in leadership with the opioid crisis is being filled by the DOJ (Jeff Sessions) and KellyAnne Conway, who thinks "will" is the key for addicts to quit.

Her appointment and Sessions loathing of drug addicts is a huge "I don't care" statement with real consequences. A Trump special.

State governments are trying to tie UAs to everything from rehab to employment to health insurance right now.

Positive results can be used against spending for treatment for addicts (and ACA covers the UAs too). Many states simply don't want to cover the cost of rehab or ORT treatment. It's pricey!

Then, "addiction treatment" on medical records will be tied to a preexisting condition.

Get ready for some "addict" labeling and once ACA is repealed through tax cuts to not be able to afford health insurance. Thanks Trump!

 

[Jabberwocky]

It is disgusting how much people makes on UAs. It's a huge part of how people are exploited who try to get treatment. It isn't unusual for insurance companies to be billed over $1000 for just one UA. Multiply that for the number of UAs that can be part of a 30 day, 90 day or longer treatment program? It's a whole lot of money that could be far better spent.

 

[spacejunk]

I will never understand people who think Trump cares about addicts.

We're flying backwards with drug policy.

you will never understand trump supporters because you can't use reason to find meaning in the tribal groupthink they seem to engage in.

in think his apologists so enamoured by his vocalisation of racist hate, that they'll cheer him on as he fucks their lives and pays russian prostitiutes to piss on their democracy (sorry, that last bit was silly hyperbole - i don't know if he paid for whatever happened in the lead-up to rthe 2016 election; Russian mafia have been funding his various global money laundering scams - er, i mean "real estate ventures")

it's ironic how his dimwit troll mobs call people "cuck", (abbreviation of cuckold), when they're happily letting an old man fuck everything they claim to love ("america first" etc etc).

it's all about tribalism with these fucking people.
and that is how they will justify it to themselves and each other - "marijuana is a liberal sjw drug".

i know i've said this before, but i miss the days when the wilfully ignorant masses thought politics was boring.
instead, their stupidity and misguided resentment has been weaponised by trump and whoever else is involved in his administration - and every scandalous headline about trump's latest dirty-old-man behaviour is to distract people from shit like this.

pretty genius move by the republicans;

- get a trash culture b-movie actor to slash the shit out of education, social services and maintain dismal workers' rights and minimum wage that doesn't come close to meeting the increases in the cost of living - creating an huge class of working poor
- 30 years later, a trash culture reality tv 'star' and shameless pervert finds his way into the presidency, using a lot of rhetoric aimed squarely at the huge numbers of people that are denied their fair share of the prosperity greedy billionaires like trump enjoy.
of course, trump hasn't blamed greedy rich folk for fucking over all of the people who can't find work, or cannot afford medical care, or housing.


trump is a fucking nasty piece of shit, and it's incredibly difficult to have any respect for anyone still insisting on supporting him and lying about how great he is. especially peiple that use drugs and post on this board.

i don't blame everyone that voted for him - i know many have regretted their vote for him, as they have admitted on social media - not everyone is politically engaged, politically informed or aware - and i've no doubt some were swept up in...whatever motivacted people to vote for him. excitement doesn't seem like the right word. resentment?

most of his campaign commitments were straight up lies or fantasy, with a lot of shit being "between the lines" - or notable by commission.

drugs were barely discussed in his campaign.
one of the biggest and most important topic in US politics, especially with the state/feds tension over cannabis
why didn't he mention it? apart from boasting that he was going to fix the opioid crisis.

my guess is that he didn't want to split his base (the libertarian far right and the traditional far right don't agree on this topic) - and because he won't be doing anything brave or principled on this matter - much like the rest of rest of his presidency - he'll try to drag his whining face-lifted corpse through the whole ordeal without sustaining too much damage.

"law and order" is a euphemosm trump (and many before him) have used to describe certain government focus on law enforcement, which i believe goes back to the nixon era.
i'm sure some of you will know what i'm talking about.


he's a fucking disgrace.

it's bad enough reading about this shit from across the pond ( i know there are literally millions of people outside america that are fearing for their lives (iran, North Korea and every country that would be within NK's striking distance, such as south korea, japan etc) because of trump - and now there is this bullshit he's started with israel/palestine - but i hope you get my point) but i really feel for all the decent americans who are having to deal with this foul-mouthed, combed-over tyrant tolddler president.
he's insufferable, and the people that support him are possibly even worse.
keep strong, keep determined and keep fighting for what is right.

the rest of us have been looking towards america with hope in the last 10 years, that maybe the country that forced drug prohibition on us might also be the country to lead us out of it.

given the overall tone of the trump administration - hovering somewhere between an auction, a circus and a lynching - i don't hold out much hope for them doing anything honourable in terms of drugs policy, given the sickos he has in his team.
jeff sessions?
fuck these people. they're seriously rotten old men who would do anything to maintain their grip on power; steal, cheat, lie, rape, nuclear holocaust.

 

[Beefy]

That is horrible. How are addicts supposed to get help and go to rehab if they can't afford it?

 

[Jabberwocky]

Our drug policy is oriented so drug users end up dead. It's been that way for over a hundred years and, on a fundamental level, that's still where it's at. This is just the most recent development in the war on our families and our communities otherwise known as the war on drugs.

 

[spacejunk]

^ exactly this.

It's why i despise these right wing mother fuckers

That is horrible. How are addicts supposed to get help and go to rehab if they can't afford it?

It's a PR boost for the "war on drugs" when people suffer and die because of drug addiction.
There is a lot of money to be made in the enforcement of drug laws and the persecution of people accused of breaking them.
As the US model demonstrates, when private prisons make a profit locking people in cages, you end up with unprecedented numbers of non-violent offenders behind bars.

Over here in australia we have politicians with the gall to argue that allowing services to operate (ie not even services run by the state) which prevent drug users from dying "sends the wrong message".

The implication there is quite obvious, and that is why i think we need to be less tolerant of elected officials who follow this sort of toxic belief system that says you deserve to die for daring to break drug laws.

 

[cduggles]

Wisconsin's Welfare Overhaul Is Almost Complete

The Trump administration could soon approve a proposal from Governor Scott Walker to drug test food-stamp recipients.

If Scott Walker has his way, poor people in Wisconsin will have to undergo drug testing, one way or another.

Last week, the Republican governor forged ahead with a plan to require testing for some recipients of the state’s Supplemental Nutrition Assistance Program, commonly referred to as food stamps. That measure would come on top of another proposal to test Wisconsin’s Medicaid enrollees, which is pending federal approval, as well as a law already on the books requiring drug screening and testing for non-custodial parents receiving Temporary Assistance for Needy Families funds. If both of Walker’s proposals pass federal scrutiny, it’ll mean all three of the major welfare programs in the state will have drug-testing components.

The move to add drug testing to SNAP is another gambit in Walker’s ongoing effort to overhaul welfare, which has included a host of reforms over the past three years. The change would affect recipients who participate in its Employment and Training Program. Through ETP, able-bodied, childless adults already have to meet work requirements in order to qualify for food stamps. Under the proposed regulation, those who test positive would be required to undergo treatment—on the state’s dime, if they can’t afford it—or face losing their benefits. The Walker administration has also sought to add work requirements and a time limit on benefits to Wisconsin’s Medicaid program, and it wants to extend the SNAP work requirements to parents.

It’s far from certain whether the latest reforms from Walker will pass federal muster. Under former President Barack Obama’s administration, Walker’s requests to implement drug testing in SNAP were denied or held up by the Department of Agriculture under the rationale that they constituted an additional eligibility barrier that Wisconsin wasn’t entitled to impose. While the state disagreed with that assessment, the argument wasn’t a new one: The Centers for Medicare and Medicaid Services, part of the Health and Human Services Department, has also traditionally denied waiver requests from states to implement work requirements and drug testing for Medicaid.

Walker may see an opening, though, under the Trump administration. Early in her tenure, CMS Administrator Seema Verma wrote a letter signaling that the agency would accept work requirements in Medicaid waivers, like the one currently being considered for Wisconsin. She also announced last month that it “will approve proposals that promote community-engagement activities,” which typically include work, job training, or community service. According to Kaiser Health News, health-care advocates expect this move from Verma presages the agency’s support for further conservative reforms affecting Medicaid eligibility, such as drug testing.

The USDA has also signaled that it is willing to consider conservative reforms to SNAP, after a federal court threw out Walker’s suit against the department over his original drug-testing proposal in 2016. Shortly after Walker sent his SNAP drug-testing regulation to the state legislature for review last week, the USDA issued a press release stressing “how important it is for states to be given flexibility to achieve the desired goal of self-sufficiency for people.” In both messaging and timing, the USDA’s release seemed to offer a direct reassurance to Walker: The terms “self-sufficiency” and “workforce development,” both of which the department included in its notice, were used heavily by Walker in his promotion of drug testing and in his welfare overhaul generally.

With the federal government sending encouraging messages on welfare reform, it’s worth considering what those changes would mean for Wisconsin’s low-income citizens. Walker has defended his SNAP drug-testing plan by arguing that “people battling substance-use disorders will be able to get the help they need to get healthy and get back into the workforce.” But it’s unlikely the rule would actually work that way. According to ThinkProgress, results from Wisconsin’s limited rollout of drug testing in TANF showed that “in 2016, at least 1.6 times as many people were denied benefits for failing to follow through on a drug test as those who tested positive.”

It’s hard to believe that the net effect of these provisions—likely a decrease in statewide enrollment in welfare programs—is an unforeseen one for Walker’s administration. The governor has trafficked in the dog-whistle stigmatization of welfare recipients as lazy, saying in a formal address advocating for drug testing that “we firmly believe public assistance should be a trampoline, not a hammock.” His insistence on this plan to encourage more “people who are drug free” ignores the fact that there are ways to accomplish the worthwhile goal of treating substance abuse that don’t involve potentially taking away food stamps.

Walker’s welfare plan could accomplish that goal by simply treating people—by offering low-cost or no-cost rehabilitation and support services to people on welfare programs, or by offering optional screening. But that’s not what Walker’s plan does, and mandatory screening will almost certainly further stigmatize a program where people of color are overrepresented.

That these welfare reforms are nearing approval as Walker is in the middle of fighting an opioid crisis is particularly ironic. A 2016 report from a special state task force found that in 2013, more Wisconsin residents died from drug overdoses than from either motor-vehicle accidents or firearm homicides. It also found that overdose deaths in the state more than tripled from 2003 to 2014. While those numbers don’t place Wisconsin near the top of the heap of states managing massive spikes of opioid-related deaths, they are extraordinary all the same. And so is the state’s prescription for bringing them down: The task force recommended the very drug-screening program that Walker is so close to implementing now.

As the Wisconsin experiment goes, so goes the rest of the country. Walker’s welfare proposals have been road maps for other states, and his SNAP plan is the first such proposal before the USDA. Other states have been eager to similarly implement drug-testing and work requirements on their welfare programs, and 18 proposed or created rules to that effect in 2015. The Obama administration was a major roadblock to the realization of those laws, but according to Politico, the Trump administration could soon echo CMS’s and USDA’s overtures with an executive order mandating a full review of all federal welfare programs. And GOP legislators have indicated that sweeping welfare reform is the next major item on their agenda.

To predict the effects of those hypothetical federal changes, perhaps it would help to examine the analyses and objections made by concerned citizens during the comment-making period of the drug-testing rule for SNAP in Wisconsin. “Commenters state that the proposed rules further complicate an already complicated application process and will turn eligible individuals away from applying [to the state’s SNAP program] FoodShare, increasing hunger in Wisconsin,” the report reads. “Others argue that if FSET participants must be drug tested then so should every government official and anyone else receiving tax dollars in any other form.”

These policies will result in decreased enrollment, denial of benefits (like 'food'), and further stigmatize the poor and drug users through expensive drug tests.

What about people who have medical marijuana cards or prescriptions for opiates, etc.? How do you maintain medical privacy and make sure people don't lose benefits? Or do poor people not deserve luxuries like medical privacy and pain medication?

Also, Sessions has argued that marijuana is not legal according to federal law. UAs will be a way to deny federal assistance like 'health insurance' for people with medical marijuana cards. (Sessions really has a thing about marijuana.) After all, people on the dole shouldn't be buying weed anyway... 8)

Addressing addiction in a meaningful way is clearly not the priority for the Trump administration. Drug testing apparently is.

 

[spacejunk]

fucking disturbing, but not at all surprising to me.

i mean, the only idiots suggesting trump wasn't going to fuck over drug users and sabotage reforms are the idiots claiming things like "trump isn't racist", "trump's not a criminal" etc etc.

delusional bullshit, but you can't force people to open their eyes, or their minds. i think it is important to ignore their bullshit though, for the sake if your own sanity.

i'm so grateful that the drug treatment i've received (several years of outpatient counselling, a couple of outpatient detoxes and an inpatient detox) were totally paid for by the government.
i hate to think how tough dealing with my drug issues would be if i was in the US.

add that to the fent epidemic and....well, it's a pretty fucking bleak picture. it makes resources like bluelight all the more valuable.

i hope you are well, CD

 

[cduggles]

^^atm, I'm more worried about you!

Tax cuts for the rich, drug tests for the poor!

 

[spacejunk]

^^atm, I'm more worried about you!

what, me worry?

Tax cuts for the rich, drug tests for the poor!

MAGA = mueller ain't going away

 

[LucidSDreamr]

Guess who all those white racist poor opiate addicts voted for? They will continue to vote against thier own interest as long as the gop continues a racist agenda

 

[spacejunk]

^ exactly.
it's the reason scumbuckets like trump use racism to attract votes. it actually has nothing to do with the people he targets - it's all about this "well, he's making healthcare unaffordable for me and my children, endangering humanity with idiotic threats of nuclear attacks on crazy rogue states and he behaves like a spiteful toddler, but at least he's sticking it to the blacks" kind of attitude.

i remember when he came out with "i love uneducated people!" - thinking
"wow, they're even ignoring the fact that he's insulting them while he panders"
that's some pathological shit.

prejudice is strictly emotional, which is why his supporters seem to be so determined that they will never by swayed by evidence. and apparently proud of it too.
fucking stupid and fucking disturbing.

what sort of 'solution' to an addiction crisis is making treatment impossible to afford?

it would be simply stupid if it wasn't so fucking wrong. and very, very sad.

i'm feel bad for you guys, my american friends. you deserve so much better than this shit.

 

[Jabberwocky]

What happened in Oz when they tried to drug test welfare recipients again spacejunk? Did that program not get implemented or did it get canceled because it didn't produce any results or is it actually happening? I forget, but it's always interesting comparing how various countries address drug policy, and Australia seems to have a lot in common with how the US does things.

 

[spacejunk]

It got defeated in parliament, thankfully.
Fucking tory bastards.

We used to be world leaders in HR initiatives (for instance needle exchanges started off here i believe) but successive conservative weasel governments have been sabotaging a lot of the goood work being done, and yeah pushing us closer to a reactionary US approach to drug use and drug treatmentt.

 

[KavaMama]

Every time I hear or read the words “the War on drugs” it makes me laugh. Not the funny haha laugh, the reality slap kind. The military is the US greatest drug supplier. I stick to what I know. Men in the army, (I’m not excluding women, just never saw any) specifically Ft Bliss, go into Mexico and bring back cocaine. The best most purest I’ve ever seen, before the baby aspirin. It’s something truly epic. Now you have your MP’s and Secfo all coked out, not all, Ft. Bliss and Holloman AFB and drug tests like a mofo. The first fail could be a fluke, so you cannot be charged unless you pop positive a second time. Then they keep doing it each day to rack and stack the same drug offense. Now, passing a drug test where someone doesn’t have to watch the urine leave the body, as in the case with welfare recipients. Just have your child pee in a cup, keep a thermometer with you, to ensure it’s 98.6 degrees, and transfer the urine into the cup they gave you. I’m aware this is somewhat off topic, but it does fall under a version of drug policy, and I feel there should be more attention brought to how certain drugs get into the US. The government wins on every front. You purchase them, they win, you become addicted, they win. You end up in the system, bonus points, game won-and over. Thank you for the vent session. Everyone have a happy, and safe Holiday

 

[Jabberwocky]

^that sounds about right to me. There military industrial complex is involve in most areas of US drug policy, and it's no surprise that drug use is something soldiers are look to engage in. That's certainly nothing new - didn't Washington require the army to give solider a pint of run each day as part of their rations?

 

[Mmp85]

I was able to go to rehab because I had insurance through the ACA.
I only had to pay a $200 copay for 28 days of inpatient treatment which out of pocket at that particular facility (I'd say it was mid-level, definitely not Promises Malibu or a spa but not a state sponsored clinic, heavy on the detox factor, a lot of medical staff) cost over $30,000.
Thanks Obama.

 

[Mr Boris]

This is my first post so apologies if I screw it up. I'm an Aussie who lived in the USA for close to 30 years and I am horrified, (sadly, not surprised) at how this "opiate epidemic" is playing out. From about 1997 until 2004 I went to a good many detoxes and rehabs in the USA and even with insurance the options were few and far between. As for methadone and, or suboxone treatment, forget it. Time and time again I saw people suddenly 'cured" and sent out the door the moment the insurance ran out. It's a completely inhumane system that is pretty well designed for failure.

As for this rhetoric on how drug tests will get more people the treatment they need - where? What treatment? Year after year after year we have called for the urgent need for affordable and accessible treatment and year after year the result is the same: increased law enforcement, mandatory sentencing, tighter and tighter regulations.

Oops, I almost forgot, what am I thinking? Why do we need treatment when all we have to do is "just say no"? Of course, The Orange One has a similar slogan to Nancy's which I've had to block from my memory. But, according to Trump, it's really so easy to stop addiction. And we all know, Trump never lies.