Advocates want Medicaid to cover room and board for substance abuse treatment

Addiction advocates want to see BadgerCare cover room and board costs associated with substance abuse treatment.

As of Feb. 1, Medicaid covers treatment for substance use disorder in a residential setting. A stay at these facilities must be clinically and medically necessary. The facility must also have 24-hour supervision. However, BadgerCare doesn’t cover the cost of room and board at those facilities.

Residential treatment involves short-term stays that typically last only several weeks. During that time, people incur expenses related to their primary residence, in addition to lost wages while in treatment. 

Gov. Tony Evers’ budget proposal called to expand Medicaid coverage for those costs. Republicans on the Joint Finance Committee nixed that along with more than 380 other proposals in the guv’s budget.

Ahead of the JFC decision, Rep. Rob Summerfield, R- Bloomer, said it’s something the Legislature can look into for full or partial funding with Medicaid. 

“There is an argument saying, if we’re going to get these people fully treated, this should be part of it,” said Summerfield, who serves as vice chair of the Assembly Health Committee.

Federal Medicaid regulations prohibit payments for room and board outside of institutional settings. State general purpose revenue funds could be used to cover these costs, but no funds are currently allocated for that purpose.

Republicans are starting with the current spending levels for their budget plan, and substance use disorder advocates are urging inclusion of Medicaid paying for the room and board costs of treatment.

“We think this measure is timely right now … because fatal overdoses are increasing in our state due to the pandemic,” said Wisconsin Voices for Recovery Outreach Specialist Jessica Geschke. 

Geschke also sits on the State Council on Alcohol and Other Drug Abuse. She noted that in a recent SCAODA briefing, she was told Wisconsin has seen a 30 percent increase in overdose fatalities during the pandemic. 

 Room and board costs at residential treatment facilities are a barrier to people seeking treatment, Geschke said, noting that costs can be upward of $600 per day.

“This leaves a large portion of our Wisconsin residents without treatment sources and thus it increases that risk of overdose or accidental death. There should be no roadblocks with their ability to get care because a room and board payment won’t be covered by their insurance,” she said of people who are released from detox and then go to a residential treatment center. 

Department of Health Services spokeswoman Elizabeth Goodsitt explained that residential SUD treatment programs serve people who need safe and stable living environments in order to stabilize and develop recovery skills. 

“Without access to these stable living environments, people are at high risk of immediate relapse, continued use, harm to themselves or others, and in some cases, death,” she said.   

In the decade leading up to 2017, the rate per 100,000 people of opioid-related emergency room visits steadily increased year over year. After dropping in 2018, the rate climbed again by 5 percent in 2019 to 43.9 ER visits per 100,000 population. But that’s still under the peak in 2017 of 52.8 ER visits per 100,000 people.  

Opioid-related deaths rose 9 percent in 2019 to 15.8 deaths per 100,000 people. That’s near the 2017 peak of 16.1 deaths per 100,000 population.

DHS also reports that Wisconsin’s estimated proportion of drug misuses in the past year is higher than the national figure by more than a half a percentage point. Heroin use in Wisconsin is higher than the national average by .2 percentage points.

BadgerCare coverage of those room and board costs would stop a cycle of people not being able to access care and continuing to use, Geschke said. Coverage would help prevent the deaths happening in Wisconsin, she said.

Listen to the latest “WisBusiness: The Podcast” episode with Geschke. 

-By Stephanie Hoff