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New Report Suggests ACA Coverage Helps Address Opioid Crisis
Published Monday, April 17, 2017

The Granite State's opioid crisis, already responsible for one of the highest incidences of drug-related deaths in the nation, could be further exacerbated by changes to the Affordable Care Act (ACA) that may reduce access to treatment for substance use disorder. A new report from the Center on Budget and Policy Priorities points to the role the federal Medicaid program plays in helping NH and other states address the opioid crisis by ensuring that individuals with substance use disorders have access to covered treatment.

According to the report, NH had the second highest rate of drug-related deaths among all states in 2015. The report argues that federal cuts to the Medicaid and Medicaid Expansion programs would hamper NH's ability to provide programs and services necessary to effectively address the state's ongoing opioid crisis.

"New Hampshire cannot afford to address this problem alone," says John Shea, executive director of the NH Fiscal Policy Institute (NHFPI) in Concord. "The federal dollars available to the state through the traditional and expanded Medicaid programs enable the state to ensure that individuals with substance use disorder can access a range of covered treatment services that not only improve their health, but also reduce the strain on the state's public safety and first responder communities."



Drug-Related Death Rate (per 100,000 in 2015)

Projected Accumulated Federal and State Cuts from 2019 – 2028

Percent Change in Current Funding

West Virginia 41.5 $5 billion -9.8
New Hampshire 34.3 $4 billion -15.1
Kentucky 29.9 $20 billion -14
Ohio 29.9 $32 billion -10
Rhode Island 28.2 $6 billion -14.8
Pennsylvania 26.3 $31 billion -10.2
Massachusetts 25.7 $23 billion -11.1
New Mexico 25.3 $13 billion -15.2
Utah 23.4 $2 billion -4.5
Tennessee 22.2 $7 billion -4.6


The ACA parity provision provides that mental health and substance use disorder coverage are considered "essential health benefits," requiring health insurers to provide this coverage and making it possible for individuals to access treatment that is covered by health insurance. The expansion of the Medicaid program enabled individuals with incomes up to 138 percent of the poverty line to access health coverage and treatment for substance use disorder. New Hampshire is one of several states that received federal approval to extend these substance use disorder benefits to the traditional Medicaid population, enabling enrollees to obtain screening, intervention, counseling and treatment, among other covered services.

As currently structured, Medicaid expands to meet need, which ensures that states receive federal support to meet increasing demand for health care services, including public health challenges such as opioid addiction. Radically restructuring Medicaid's financing system by converting it to a per capita cap, as has been proposed, would eliminate Medicaid's automatic response to need, and shift costs to NH, likely forcing the state to cut services, reduce eligibility and stop testing new models of treatment or recovery supports.

"Federal Medicaid dollars are vital to sustaining many of the state's hospitals and community health centers, particularly those in rural and underserved regions of the state," says Shea. "The loss of these federal funds would have a devastating effect on New Hampshire families and communities."

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