Virginia Department of Medical Assistance Services

The Virginia Department of Medical Assistance Services is part of Dopesick’s account of the gap between effective opioid treatment and patients’ ability to obtain it. Through changes to Medicaid reimbursement and coverage for counseling and care coordination, state officials sought to make medication-assisted treatment more accessible and to encourage clinics to accept insurance, including Medicaid.

Role in treatment access

In 2017, access to medication-assisted treatment in Virginia began to broaden through work involving Dr. Hughes Melton, an addiction specialist tapped to help lead the state’s opioid response, and state Medicaid officials. Melton also worked with those officials on reimbursement changes and on including payment for counseling and care coordination. The measures addressed not only whether a patient could receive medication, but also whether the surrounding services required by treatment providers could be reimbursed.

The account places these changes against a severe shortage of treatment capacity. Federal rules at the time limited MAT-certified doctors to 100 patients each; the limit was raised to 275 later that year. Even as access began to expand, treatment needs remained far greater than the available services, and improvements took time to reach communities.

Reimbursement and the cost of care

The reimbursement issue mattered because some addiction clinics operated on a cash-only basis. New Virginia regulations that improved reimbursements in April 2017 were intended to nudge such clinics toward best practices, including accepting insurance. For patients, insurance coverage for medication did not necessarily remove the cost of attending a clinic or receiving follow-up care.

Tess Henry’s experience illustrates that distinction. Her insurance covered 80 percent of her buprenorphine medication, but visits to her addiction doctor were cash-only: she needed $700 up front and then $90 to $100 for each follow-up appointment, which could occur as often as four times a month. Her mother, Patricia Mehrmann, also described waiting lists at treatment providers. These costs and delays show how a medication could be partly covered while regular access to the clinician monitoring treatment remained financially difficult.

Connecting patients to services

The Hope Initiative’s referral process also made insurance and affordability practical questions in arranging care. Its volunteers used a five-page spreadsheet listing 36 rehabilitation and aftercare providers in the southeastern United States, contacting facilities according to a patient’s finances and the availability of beds. Social-service workers at the Bradley Free Clinic helped eligible patients apply for Medicaid. The effort depended on matching a person not simply with a treatment type, but with a provider able to take that person under the circumstances available.

The department’s place in this account is therefore tied to the implementation of coverage: reimbursement rules could influence whether treatment providers accepted Medicaid and whether related services could be paid for. The book presents policy changes as an important step in widening access, while emphasizing that provider capacity, waiting lists, and the costs of ongoing care continued to shape whether treatment could be sustained.