The Centers for Medicare & Medicaid Services (CMS) has approved a Medicaid demonstration project that broadens treatment services available to Medicaid beneficiaries living in Washington, D.C., diagnosed with serious mental illness (SMI) and/or serious emotional disturbance (SED). CMS also approved the District’s request to begin providing new services for its beneficiaries diagnosed with substance use disorder (SUD).
The District is the first in the nation to receive federal approval of the new SMI/SED opportunity first described in a letter to state Medicaid directors in late 2018.
The SMI/SED section 1115 demonstrations will allow state Medicaid programs to overcome a longstanding payment exclusion which will, in turn, allow them to treat individuals with serious mental illness who are short-term residents in settings that qualify as institutions for mental disease (IMD). The District is also taking advantage of CMS’s demonstration opportunity that offers similar flexibilities for Medicaid beneficiaries diagnosed with opioid use disorder (OUD) or other SUDs.
“Today’s historic approval will substantially increase the range of services that are available to meet the needs of the District’s Medicaid beneficiaries who are diagnosed with serious mental illness and substance use disorder,” said CMS Administrator Seema Verma, in a statement. “This integrated approach supports the District’s goals of reducing opioid misuse and overdose deaths – while expanding the continuum of mental health and substance use treatment options for individuals in need.”
The District has been especially hard-hit by the nation’s opioid crisis and has witnessed opioid-related fatal overdoses increase by 236 percent from 2014 to 2017. In addition, about one-third of the District’s adult residents who are treated for OUD/SUD have a co-occurring SMI, which means that this combined SMI/SED and SUD demonstration has the potential to save thousands of lives.
This demonstration will also support the District’s goals to meet the needs of people experiencing homelessness. Studies consistently reveal that large proportions of chronically homeless people have SMI, SUD or both, and today’s approval of the District’s combined SMI and SUD demonstration is expected to improve access to acute care, residential treatment, crisis stabilization and other mental health and SUD services.
