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Mr. President: This is the fastest way to provide more drug treatment

Last week President Trump declared the opioid epidemic and emergency. He did not offer details but assured us his administration will be “spending a lot of time, a lot of effort and a lot of money” on the opioid epidemic.

If he is serious about this, he would immediately order the Department of Health and Human Services to grant waivers to states that wish to eliminate the federal Institute for Mental Diseases exclusions in the Medicaid program.

This arcane and illogical component of the Social Security Act prevents Medicaid reimbursement for certain services for “mental diseases” provided in a facility that has more than 16 beds.

This means a mental health facility with 17 beds won’t get reimbursed by Medicaid for treating a poor person with a “mental disease” – bipolar disorder, schizophrenia, substance and other disorders.

The exclusion was intended to encourage states to provide community-based mental health services, rather than to rely on inpatient treatment. We all know how well that has worked out. Not.

Instead, poor people suffering from chronic mental illnesses end up in emergency rooms, where their Medicaid bills soar.

Granting waivers to states seeking an IMD exclusion would immediately open up treatment beds to thousands of Americans.

“This is the single fastest way to increase treatment availability across the nation,” according to the interim report released by the President’s Commission on Combating Drug Addiction and the Opioid Crisis. 

What are the odds of this happening? Not good.

Expanding Medicaid is not a component of Republicans’ efforts to repeal and replace the Affordable Care Act.

Opponents of the exclusion have been trying to get rid of it for years. In May, a bipartisan bill was introduced that would do just that.

But the president could hopscotch over the legislative process by directing Tom Price, head of the Department of Health and Human Services, to start granting waivers.

Any effort to eliminate or circumvent the waiver would require extraordinary bipartisanship and compassion. You would think an epidemic that kills 100 Americans a day might give the effort a little oomph.

We shall see.







Mr. President: This is the fastest way to provide more drug treatment

Christine Stapleton

Christine Stapleton has been a journalist for 35 years. She is now an investigative reporter for The Palm Beach Post. In 2006, began writing a blog for PsychCentral called Depression on My Mind. Her latest blog, Addiction Matters, draws on her 19 years of sobriety and her coverage of the drug treatment industry in South Florida.

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APA Reference
Stapleton, C. (2017). Mr. President: This is the fastest way to provide more drug treatment. Psych Central. Retrieved on March 23, 2019, from


Last updated: 20 Aug 2017
Last reviewed: By John M. Grohol, Psy.D. on 20 Aug 2017
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