What challenges do states face in expanding access to family centered care programs?
Despite the promise of these programs, multiple barriers limit the adoption of these models. For example, stakeholders interviewed in our study identified a lack of Medicaid reimbursement for case management and other support services delivered by non-clinical professionals such as peer recovery coaches, patient navigators, and lactation consultants as a prominent barrier. Many of these services fall outside what is considered “traditional” clinical treatment but are considered central to delivering family-centered MAT.
Interview respondents also noted that a shortage of addiction professionals (i.e. clinical social workers, substance abuse counselors, and psychiatrists) as well as physicians and nurse practitioners certified to deliver MAT limits states’ ability to expand access to treatment. Finding trained substance use disorder professionals is particularly problematic in rural areas.
Lastly, provider resistance to treating pregnant patients with OUD further inhibits states’ efforts. Despite clinical guidance from the Substance Abuse and Mental Health Services Administration4, the American College of Obstetricians and Gynecologists5, and the American Society of Addiction Medicine6 that recommends MAT for pregnant women with an OUD, some Ob/Gyns are hesitant to treat these patients. Lack of training and internalized biases contribute to this resistance and may prevent women from getting the care they need.
What can states do to incentivize family centered care and improve outcomes for pregnant women addicted to opioids?
Stakeholders had a number of suggestions for how federal and state policymakers could expand access to family-centered treatment for pregnant women with an OUD:
- Create more sustainable and flexible funding streams for OUD treatment and recovery. States are applying a patchwork of funding sources to support family-centered MAT programs, including Substance Abuse Prevention and Treatment Block Grants, State Targeted Response (STR) funds, and state funds. States are also using Medicaid 1115 Waivers and State Plan Amendments to expand access to MAT. However, many of these funding sources are time limited, making states reluctant to invest in comprehensive treatment programs that might lose financing in 2-3 years. Creating more dedicated funding streams to support states OUD activities would help ensure their longevity in years to come.
- Enable providers to experiment with more Alternative Payment Models (APMs). By incentivizing care integration and care coordination , APMs allow providers flexibility to design innovative programs that meet the needs of pregnant women and families impacted by OUD. The Centers for Medicare & Medicaid Services recently announced additional support for APMs with its recent funding announcement for states to implement a Maternal Opioid Misuse Models (MOM) designed to foster the coordination of clinical and non-clinical care for pregnant and postpartum women with OUD.7
- Incentivize and train more health care practitioners to become certified MAT providers. To combat stigma and reduce anxiety about treating patients with an OUD some states have enlisted the help of certified MAT practitioners to mentor and coach other physicians on the importance of delivering MAT to patients with an OUD.
Just as addiction affects the whole family, it too can be treated within the family context. Given the devastating consequences of the opioid epidemic on mothers, children, and families, states would be wise to develop and fund more family-centered programs like these.