GOP panel proposes lifting Medicaid limits on opioid care

Republicans on the House Energy and Commerce Committee on Wednesday night unveiled a proposal to lift limits on Medicaid paying for opioid treatment.

The proposal could be one of the more significant and costly steps that Congress takes to fight the opioid epidemic, but there are concerns about how to pay for it. 

Members of both parties have called for lifting these limits on Medicaid paying for treatment at facilities with more than 16 beds, saying they are a major barrier to care as lawmakers work on a package of opioid bills that could reach the House floor by Memorial Day.

The summary of a bill unveiled Wednesday night would lift those limits specifically if the care is for substance abuse treatment and lasts less than 90 days.

But there are areas of contention: Democrats are worried that the new spending on the bill would have to be offset, which could lead to cuts elsewhere that they find harmful.

A spokesman for Democrats on the committee did not specifically endorse the new proposal, which lifts limits known as the “IMD exclusion,” but said members of both parties want to work on the issue.  

“Both Democratic and Republican members have expressed a concern with the IMD exclusion and there is interest in working on policy that preserves and expands access to the full range of providers to treat substance use disorder in Medicaid,” the spokesman said.

{mosads}It is not clear how much the bill will cost, but it could be a hefty sum. The Congressional Budget Office previously said a full repeal of the limits, for mental health and substance use, would cost up to $60 billion over 10 years.

A spokesperson for Republicans on the Energy and Commerce Committee did not give an exact cost for the bill, but indicated it would be less than $60 billion, saying steps like limiting the move to only the area of substance abuse would result in a “reduced CBO score.”

The spokesperson said the bill would have to be paid for but that offsets had not been decided yet.

Eliot Fishman, senior director of health policy for Families USA, a major liberal health-care advocacy group, expressed concerns with the proposal.

He said the money would be better spent not on extended overnight stays at treatment facilities but on care in the community. And he expressed worries about potential cuts from offsets.

“The only way we could get behind this bill is if the offsets were supportable and if budgetary room was made for a major increase in community-based treatment as well,” he said.