Overview
The Centers for Medicare & Medicaid Services (CMS) approved Oregon’s Substance Use Disorder 1115 Demonstration waiver, effective April 8, 2021, through March 31, 2026. A central part of the waiver focuses on enhancing residential treatment services as a crucial component in the continuum of substance use addiction benefits. It accomplishes this by permitting Oregon to receive federal funding for Medicaid services for individuals with a substance use disorder (SUD) in residential treatment facilities with more than 16 beds.
This new federal funding, added to the resources provided in the Governor’s Budget for 2021-23, allows for greater investment in Oregon’s vision to prevent, identify, and treat people with substance use disorder and help them sustain long-term recovery.
The other major component of this waiver increases the service array for Oregon Health Plan (OHP) members with substance use disorders, including Community Integration services composed of housing and employment support.
At the guidance of CMS, the proposed Recovery Support Services were separated out from this waiver. This means peer-delivered services outside of a treatment episode will be considered for further conversation and development in the future.
For additional information or inquiries,
please contact Dalila Morales, SUD Policy Analyst.
Current Demonstration
This waiver has the potential to profoundly change Oregon’s SUD treatment system.
We believe substance use disorder is a chronic condition that needs long-term comprehensive care and support. Oregon envisions a person-centered and recovery-oriented system that supports prevention, treatment and ongoing support for sustained recovery. Before this demonstration:
- Oregon could not use Medicaid funds to pay for residential treatment in facilities with more than 16 beds. Most of Oregon’s residential treatment facilities are more than 16 beds and solely state-funded.
- Only treatment was eligible for Medicaid funding (not prevention, outreach, or recovery support).
The SUD 1115 waiver would allow Oregon to pay all residential facilities using Medicaid funds. OHA will use these new funds to also provide the supports needed to prevent substance use disorder, identify substance use disorder and sustain long-term recovery.
OHA requested and received approval for this amendment upon advisement from CMS on how to modify a risk mitigation arrangement with coordinated care organizations after the applicable rating period has begun in order to make appropriate equitable payments during the COVID-19 Public Health Emergency.