California’s Medicaid program, Medi-Cal, is a vital tool in the state’s fight against the opioid epidemic. The program covers 13 million Californians—one third of the state’s residents–and provides comprehensive coverage to low-income individuals with opioid use disorders (OUD) who are at risk of opioid-related overdose. By cutting $30 billion from Medi-Cal’s budget, however, the Senate’s Better Care Reconciliation Act (BCRA), the Affordable Care Act (ACA) repeal legislation, would shift Medi-Cal costs to the state and would increase the burden of the epidemic.
The opioid epidemic in California has risen sharply in recent years. Preliminary data show that more than 4,600 Californians died of a drug overdose in 2016. Access to OUD prevention and treatment services is essential to reduce the number of overdose deaths, but without Medicaid coverage low-income individuals with OUD would be unable to access these services. As a result of ACA, Medicaid now covers 1.2 billion Americans with substance use disorders (SUD) in states that expanded Medicaid, including California.
Medi-Cal coverage of substance abuse services is generally more comprehensive than private plan coverage. The program covers all three medications approved for the treatment of SUD and pays for 16 percent of all buprenorphine prescriptions in the state. Since California expanded Medi-Cal, the number of physicians waivered to prescribe buprenorphine in the state has increased 34 percent. Medi-Cal is also an important source of coverage for the overdose-reversal medication naloxone. In 2016, Medi-Cal-covered naloxone helped reverse 705 overdoses in California.
Medi-Cal is also an open-ended entitlement, which means that low-income eligible individuals can enroll and access OUD services when they most need them. The current Medicaid financing structure ensures that, in times of public health emergencies like the current opioid epidemic, California and other states can expand access to treatment to their low-income residents without fear of limited federal funds.
Recent actions at the federal level, however, have threatened the role of Medi-Cal in fighting the epidemic. If enacted, BCRA would end the Medicaid expansion’s enhanced federal funding and would cap the amount states receive for their Medicaid programs. These actions would result in deep cuts to federal funding, which would jeopardize the availability of Medi-Cal for millions and lead to less comprehensive OUD coverage. Among the likely consequences of these cuts that would affect individuals with OUD at risk of overdose are:
- Eliminating Medi-Cal eligibility for low-income, expansion adults with OUD. Seeking to lower costs, California may reduce or eliminate coverage for optional populations, including low-income, adults with OUD eligible under the expansion. The state may also seek to eliminate coverage of optional OUD services, some of which are essential to reduce the number of overdose deaths.
- Imposing burdensome utilization controls on OUD services. Utilization controls, like prior authorization, simultaneous counseling requirements, quantity limits on MAT coverage, and “lock-in” programs, would reduce access to medically necessary care for Californians with OUD.
- Weakening of the mental health and SUD parity rule. Since the parity rule only prohibits Medi-Cal from imposing limitations on OUD services that are more onerous than limitations on medical and surgical benefits, if coverage of medical and surgical benefits is reduced as a result of federal funding cuts, California may also seek to reduce the array of OUD services currently covered.
See our Protect Medi-Cal Series, Issue Brief #10, for a “deeper dive” on the importance of Medi-Cal for individuals with OUD who are at risk of overdose, and how Medi-Cal’s role in fighting the opioid epidemic would be threatened by Medicaid funding cuts.
Published Blogs in the Series:
Why Medicaid Cuts Would Harm Health Care for California’s Children
Medi-Cal Cuts Will Harm Health Care for Women In California
Medi-Cal is Critical for Older Adults and Individuals with Disabilities
Medi-Cal Cuts Will Eliminate or Reduce Access to Necessary Services
Medicaid Cuts Would Undermine Medi-Cal’s Ability to Provide Affordable Care to Calif.’s Most Vulnerable People
Proposed Medicaid Cuts Would Endanger Calif.’s Ability to Address Health Disparities
Senate’s Effort to Gut Medicaid Threatens Calif.’s Ability to Provide Care for Women Living with HIV
Republican Policy to Slash Medicaid Funding Would Endanger Calif.’s Enrollment and Coverage Protections