In a recent opinion editorial, Senator Brian Helton argued that West Virginia’s efforts to treat substance use disorder via Medicaid have failed. But in his analysis, he misunderstands the windy path of recovery and Medicaid’s successes in saving lives across West Virginia.
He opens with a big number: that the state spent “more than $240 million” on medication-assisted treatment last year—but that figure represents less than 5 percent of Medicaid spending over that period. And in reality, the state is footing just one-tenth of that bill, given the 90 percent federal funding match provided for West Virginia adults covered in the expansion population. Put that way, our spending on medication assisted treatmentprograms constitutes less than one-half of one percent of the state’s general revenue budget.
And if West Virginia does not address substance use with atreatment-based public health response, we will pay for it in other parts of the budget. Research consistently shows that access to community-based substance use treatment, particularly via Medicaid, reduces criminal system involvement and that the inverse is also true. That means if we slash access to treatment via Medicaid, where every state dollar spent pulls down severalfederal dollars, we will pay for it instead in the criminal system, which is almost entirely state and locally funded.
But the issues with his argument are larger than that. West Virginia’s efforts are not failing. Over the last year, our state saw a nearly 40% decline in drug overdose deaths—the largest drop of any state in the country (for comparison, the rate declined by 24.5% nationally over the same period). This represents the largest year-over-year improvement on record—progress worth celebrating, not demolishing.
Key to that success has been West Virginia’s first-in-the-nation Medicaid waiver to expand and improve substance use treatment, approved by the Trump Administration in 2018. Since then, West Virginia has been seen as a model for the nation in utilizing state and federal Medicaid dollars to increase access to life-saving substance use treatment. Using Medicaid as a proactive, front-end treatment means that we are reducing the burden on our police, first responders, hospital staff, and criminal system down the line.
And those with loved ones who’ve experienced substance use disorder know that recovery is not linear. Research shows that people with substance use disorder typically require multiple quit attempts (often averaging two to five tries) before successful recovery. It would be in direct conflict with the evidence —and harmful to our progress—to reduce access to medication assisted treatment or to punish providers for relapseswhen we know the path to successful recovery takes a couple of tries. Medication assisted treatment is considered the gold-standard for treating opioid use, with better rates of long-term recovery than abstinence-only programs.
All of this is not to say that West Virginia does not have serious substance use issues to overcome. Despite our historic decline in overdose deaths, West Virginia still has the highest rate of overdose deaths of any state per capita. We know well why that is—not because of any defects of our people, but because the pharmaceutical industry intentionally targeted and saturated West Virginia’s coalfield residents with huge shipments of opioids to make profits off our people’s pain. They did so by shipping 780 million hydrocodone and oxycodone pills into thestate—or more than 458 pills per every man, woman, and child in West Virginia—over six years, according to an investigation by the Charleston Gazette-Mail. No other state saw that volume of opioid pills flood their borders or target their people, which is why West Virginia received the largest drug company settlements per capita of any state. And why it will take us time to recover.
Medicaid-funded treatment is the strongest tool in our arsenal to address substance use disorder. Over the last 18 months, the program expansions we’ve built over the last several yearswithin Medicaid have shown significant progress with the largest decline in overdose deaths in history. The worst thing we could do at the precipice of turning the tide is to unilaterally disarm by restricting Medicaid access to treatment.
Kelly Allen is the executive director of the West Virginia Center on Budget and Policy, an independent policy research organization dedicated to advancing policies that improve the economic mobility and qualify of life of all West Virginians.
