Individuals in Medicaid Deserve Care That is Appropriate and Responsible in its Execution Act

Floor Speech

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Ms. MAXINE WATERS of California. Mr. Chair, I rise to oppose H.R. 5797, also known as the ``IMD CARE Act.''

H.R. 5797 allows states to use Medicaid funds to treat adult patients ages 21-64 with opioid abuse disorders in Institutions for Mental Disease (IMDs) with more than 16 beds. While expanding access to treatment for substance abuse disorders is an admirable goal, H.R. 5797 is not the way to accomplish this goal.

One obvious limitation of H.R. 5797 is that it only applies to opioid and heroin use disorders. It does nothing to expand access to treatment for other types of substance abuse disorders, including alcoholism and the abuse of other illegal drugs like methamphetamine, crack, and other forms of cocaine.

A second problem with this bill is that it only expands access to treatment in inpatient IMD facilities. It does not provide Medicaid funding for substance abuse treatment services in an outpatient setting, nor does it require states to make such services available. Not all substance abuse patients need to be treated in an institution, and those that do will also need outpatient recovery services after they are released from an IMD.

Currently, states can already use Medicaid funds to treat patients in IMD facilities by means of a waiver from the Centers for Medicare and Medicaid Services (CMS). In order to qualify for a waiver, states must take steps to ensure that patients are able to obtain substance abuse treatment and services in the community, as well as in institutions. Eleven states already have a waiver for this purpose, and eleven other states have waiver applications pending. Expanding access to inpatient treatment in states that do not provide outpatient services risks forcing patients into treatment that is ineffective and inappropriate for their situation.

Another option that is already available for states that want to expand access to substance abuse treatment services is to expand Medicaid under the Affordable Care Act. Medicaid expansion would ensure that all low-income people, including those with substance abuse disorders, are able to obtain treatment for their medical conditions.

I submitted an amendment that would have required states to expand Medicaid pursuant to the Affordable Care Act as a condition for using Medicaid funds to treat people with opioid abuse disorders in IMD facilities. This amendment would have provided an additional incentive for states to expand Medicaid, which in turn would have expanded access to a broad range of treatment and services for patients with substance abuse disorders.

Expanding access to Medicaid will benefit patients with substance abuse disorders, regardless of the type of addiction from which they suffer and regardless of whether they would be best served by inpatient treatment, outpatient treatment, or a combination of the two.

It is especially ironic that this bill is being considered on the House floor the day after House Republicans unveiled their fiscal year 2019 budget proposal, which would cut $1.5 trillion from Medicaid. If the majority party cares about Americans suffering from an opioid abuse disorder, they would not rob them of the health care services thiey already have.

I urge my colleagues to oppose H.R. 5797 and support a comprehensive solution to substance abuse disorders that will meet the needs of all people suffering from these tragic medical conditions.

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