Changes to Institutions of Mental Disease in Medicaid under the SUPPORT Act

In October 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) to address the ongoing opioid epidemic. For state Medicaid programs, one key impact is the availability of substance use disorder (SUD) treatments through Institutions of Mental Disease (IMD) facilities where Medicaid recipients have been historically unable to receive care that qualifies for federal matching funds. The SUPPORT Act provides a simpler way for states to include IMD facilities in their fee-for-service and managed care delivery models—a state plan amendment (SPA).

With the expansion of options under the SUPPORT Act, states will need to consider whether or not their goals for treating SUD patients in IMDs can be achieved under the simpler SPA process with its inherent limitations from the SUPPORT Act or if the more complicated but more flexible waiver process remains their best option.

In this paper, Milliman’s Christopher Kunkel, Catherine Lewis, and Jie Savage explain the changes to IMDs in Medicaid under the SUPPORT Act.