Section 1115 Substance Use Disorder Waivers: Opportunities and Limitations

Area of Science:

• Health Services Research
• Public Health Policy
• Substance Use Disorder Treatment

Background:

• Substance Use Disorder (SUD) affects millions in the US, with a significant portion having Opioid Use Disorder (OUD).
• Medicaid is the primary insurer for OUD treatment, covering nearly 40% of individuals with OUD.
• The Institutions for Mental Diseases (IMD) exclusion and Medicaid inmate exclusion pose significant barriers to accessing SUD treatment within the Medicaid program.

Purpose of the Study:

• To provide a timeline of reforms related to SUD waivers addressing the IMD and Medicaid inmate exclusions.
• To assess the effectiveness of state-level SUD waivers in expanding treatment access.
• To identify implementation challenges and policy risks associated with these waivers.

Main Methods:

• Review of waiver reforms over time and across states.
• Analysis of existing evidence on the impact of SUD waivers, focusing on IMD exclusion waivers.
• Examination of implementation challenges and policy risks.

Main Results:

• SUD waivers addressing the IMD exclusion show varied implementation and emerging evidence of effectiveness.
• Medicaid inmate exclusion waivers are too recent for systematic evidence assessment.
• Outstanding challenges and policy risks associated with waiver implementation require further attention.

Conclusions:

• SUD waivers represent a critical policy lever for improving treatment access for Medicaid beneficiaries.
• Continued monitoring and evaluation are necessary to understand the full impact of these waivers.
• Addressing remaining systemic barriers is crucial for comprehensive SUD care within Medicaid.