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Your Guide to Virginia Medicaid Coverage and Opioid Addiction Treatment

 

In the face of our nation’s opioid crisis, Virginia stands as a pioneer for positive change. The Virginia Department of Medical Assistance Services (DMAS) recently rolled out significant Medicaid policy changes that increase both Medicaid eligibility and access to medication assisted treatment (MAT) – a lifesaving treatment for people struggling with opioid addiction.

MAT combines anti-addiction medications like buprenorphine – known by its brand name Suboxone – with behavioral therapy and case management. Studies show MAT can reduce the death rate among opioid addiction patients by half or more. Additional research shows anti-addiction medications do a better job of keeping people in treatment than treatments that don’t use anti-addiction medications.

With wider access to Medicaid and a growing number of regional offices that provide MAT, Virginians have more options to successfully treat opioid addiction.

Do You Qualify for Virginia Medicaid Now?

Medicaid is the largest national source of coverage and funding for substance use prevention and treatment. The program covers treatment for nearly 40 percent of adults with an opioid addiction.

Medicaid coverage is now available for adults between the ages of 19 and 64 and earn up to 138 percent of the federal poverty level. That means a single adult making up to $16,754 or a family of three making up to $28,677 can now apply for Medicaid.

Unlike open enrollment, which closes on December 15, you can apply for VA Medicaid at any time, even if you’ve been denied in the past.

If you’re unsure whether you qualify or if you have been denied in the past, SaVida Health can help you determine eligibility and walk you through the application process.

Virginia Medicaid Expansion of Addiction Treatment

DMAS implemented the Addiction and Recovery Treatment Services (ARTS) program in April 2017 to increase treatment access for Medicaid members with opioid addiction. In its first 15 months of operation, the ARTS program increased the number of Virginia Medicaid members receiving treatment for opioid addiction from 9,000 to nearly 16,400.

ARTS is also offering training and financial incentives to increase MAT provider participation. More providers means better access to opioid addiction treatment in places like Front Royal.

Specifics of the Virginia Medicaid Expansion and MAT Access

Here’s a summary of the changes in opioid addiction treatment and access through the ARTS benefit:

  • Treatment with Suboxone film can begin immediately in doses up to 24 milligrams per day. Prior authorization is no longer required from DMAS or its Medicaid health plans for prescriptions written by in-network practitioners.
  • Virginia Medicaid prescription coverage only applies to the preferred product, which is Suboxone film. Prescriptions must come from in-network waivered clinicians who are credentialed and contracted with Medicaid Managed Care Organizations (MCOs) for managed care enrolled members or DMAS enrolled waivered practitioners for fee-for-service members.
  • Virginia Medicaid members who receive a prescription for Suboxone films are no longer automatically “locked-in” to a prescriber or group of prescribers.
  • Virginia Medicaid members must also be prescribed the overdose reversal agent naloxone with Suboxone since they are at an elevated risk for overdose. When possible, family members and significant others must also be trained in the use of naloxone.
  • Relapse is a common occurrence with opioid addiction. DMAS encourages providers to use urine drug testing as a therapeutic tool, but providers are urged not to discharge patients based on relapse and/or positive drug test results.

 

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