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April 4, 2017

Virginia lawmakers have a chance to take a big step in addressing the state’s opioid crisis on Wednesday. It’s called Medicaid.

In 2015, more than a 1,000 people in Virginia lost their lives to opioids. That’s a 22 percent increase since 2013. Heroin overdoses have been particularly problematic in the state, increasing nearly 39 percent from 2014 to 2015. Research shows that people with health coverage are much more likely to get timely care and access effective treatments for opioid use disorder, and that’s why lawmakers should act to expand Medicaid coverage when they reconvene in Richmond on Wednesday. Expanding Medicaid could be the single most effective tool to address the state’s increasingly dire opioid epidemic.

Today there are around 102,000 individuals in Virginia with substance use disorder (SUD) or mental illness who could become eligible for Medicaid coverage if lawmakers decided to accept federal funds to expand – as 31 other states and D.C. have already done.  

Medicaid expansion has proven highly effective for assisting individuals with SUD, as beneficiaries tend to take advantage of newly affordable treatment services. Kentucky had a 700 percent increase in beneficiaries using SUD services after expansion. Overall, expansion has been associated with reducing unmet needs for SUD treatment by 18.3 percent.

When people do not have health care coverage, often times they will not seek services until they experience a crisis. Virginia has seen nearly a 17 percent increase in the amount of uninsured SUD related hospital stays since 2013 – the fourth highest rate out of all states (for which data is available). The vast majority of states have seen a decrease in these types of uninsured visits over this period, including neighboring states that expanded Medicaid like West Virginia (down 79 percent) and Kentucky (down 86 percent).  The share of uninsured SUD hospitalizations in expansion states fell from 20 percent in 2013 to 5 percent in 2015. Non-expansion states saw a very minimal change over this same period.


For individuals with SUD, Medicaid has been found to be more comprehensive than most private insurance – especially in providing coverage for medications to treat opioid addiction. Around one third of those with SUD have an opioid use disorder. Medication has proven to be one of the most effective treatments for this disorder. Access to these life saving medications is generally out of reach to uninsured individuals. For example, one of the most effective medications, buprenorphine, costs around $6,000 annually. Nearly a quarter of all buprenorphine medications nationally are paid for through Medicaid. And states that expanded Medicaid saw an average increase of 70 percent in Medicaid-covered buprenorphine prescriptions in 2014.

Expanding Medicaid coverage for the 400,000 Virginians who would be eligible does not have to cost to the state a dime. Under the Affordable Care Act, the federal share of Medicaid coverage will never fall below 90 percent, and the Virginia Hospital and Healthcare Association has offered that hospitals would be willing to cover the remaining 10 percent of the state share. The expanded coverage from Medicaid could not only reduce opioid usage, but could also save the state money. One recent study estimated the national cost of the opioid epidemic at $78.5 billion, with 25 percent of the cost coming from lost labor force participation and 10 percent from criminal justice-related costs to states and local governments.

In November, Virginia’s state health commissioner declared the opioid epidemic a public health emergency. Not expanding Medicaid is shutting the door on the most expansive and effective way to substantially address and begin curbing this epidemic. With the opportunity to generate hundreds of millions of dollars in state savings, cover hundreds of thousands of Virginians without a net cost to the state, and save countless lives from an epidemic that destroys quality of life and families, it’s time for lawmakers to stop playing politics with people’s lives and make the easy decision to put their constituents’ well-being first.

Health Care

Chad Stewart

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