Expanding Access to Addiction Treatment Services through Section 1115 Waivers for Substance Use Disorders: Experiences From Virginia and Maryland


In response to the nation’s opioid epidemic, an increasing number of states are applying for and receiving Medicaid Section 1115 demonstration waivers for substance use disorders. The Centers for Medicare and Medicaid Services (CMS) created this opportunity under the authority of section 1115(a) of the Social Security Act for states to draw down federal Medicaid payments for facilities with greater than 16 beds that provide short-term residential treatment, which are otherwise prohibited through the Institution for Mental Disease (IMD) exclusion. Waiving the IMD exclusion allows states to offer short-term residential treatment, thereby offering the entire continuum of addiction treatment services to their Medicaid members based on widely accepted standards for evidence-based care.

This research was supported by the Robert Wood Johnson Foundation’s Research in Transforming Health and Health Care Systems program, which is administered by AcademyHealth. Hilltoppers Cynthia Woodcock, Alice Middleton, David Idala, and Matthew Clark co-authored this report, which describes the experiences of two early adopters of IMD waivers, Maryland and Virginia, in terms of their implementation and impact on the addiction treatment system for Medicaid members.

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