Policy News Roundup: April 18, 2024

Key reads

Jurisdictions are using opioid settlement funds to replace existing funds rather than supplement them

Instead of spending opioid settlement money on new addiction treatment and prevention services they could not afford before, some jurisdictions are using it to replace existing funds and stretch tight budgets. For example, counties have spent funds on salaries for health directors and emergency medical services staff, drug court programs and other addiction programs that existed previously using other funding. The national settlements do not prohibit the use of money for initiatives already supported by other means, but families, advocates and legal and public health experts say doing so squanders the opportunity of additional resources. They note that the spirit of the settlements was not to keep doing the same thing, which is not going to help. Thirteen states and D.C. have restricted the practice of substituting opioid settlement funds for existing dollars, and the Johns Hopkins principles advise against the practice.

Source: Swap Funds or Add Services? Use of Opioid Settlement Cash Sparks Strong Disagreements (KFF Health News)

Adolescent behavioral health crisis ripple effects include $185 billion in medical costs and $3 trillion in lost productivity and wages

A United Hospital Fund analysis found that approximately 6.7 million adolescents in the U.S. suffered from one or more behavioral health conditions in 2022. Based on the 2022 prevalence of adolescent behavioral health conditions and symptoms, the ripple effects are estimated at up to $185 billion in lifetime medical costs and $3 trillion in lifetime lost productivity and wages. High schoolers who report persistent sadness are three times more likely to use illicit substances and 2.3 times more likely to engage in binge drinking. Access to behavioral health prescribers varies by state. The national average is 207 prescribers per 100,000 youth. Nevada and Texas have the lowest availability (147 and 152). To tackle the adolescent behavioral health crisis, the shortage of clinicians must be addressed. Initiatives that empower non-clinical staff to intervene early with adolescents; encourage adolescents to share their stories and fight against stigma; and foster communication between families, schools and communities can help address needs in tandem with traditional clinical behavioral health interventions.

Source: National Analysis Reveals Growing Adolescent Behavioral Health Crisis, Rising Unmet Need—and the Ripple Effects on Education, Family Economics, Health, and Productivity (United Hospital Fund)

Lawmakers question Califf on tobacco and vaping regulation

Food and Drug Administration (FDA) Commissioner Califf fielded questions during a House Oversight Committee hearing last week. Democrats and Republicans pressed Califf on the FDA’s slow pace when evaluating new tobacco product applications. Califf insisted the FDA is making progress, having processed 99% of the applications. But members said the agency has ignored “serious” marketing proposals that could meet FDA standards. Lawmakers in both parties also questioned Califf over the proliferation of flavored vape products imported from China that appeal to kids. Califf said, “It bothers me as much as it does you to see what’s on our shelves.” He said the agency has ramped up its enforcement efforts through warning letters and fines, and that he has met with Border Patrol agents and Justice Department officials about the issue.

Source: Califf’s long day on Capitol Hill (Politico); Lawmakers quiz FDA chief on tobacco regulation, mifepristone and bird flu (The Washington Post)

House committee report investigates China's role in the fentanyl crisis

The House Select Committee on the Strategic Competition Between the U.S. and the Chinese Communist Party (CCP) revealed findings from an investigation on the CCP’s role in the fentanyl crisis. The investigation found that the Chinese government directly subsidizes the manufacturing and export of illicit fentanyl and other synthetic narcotics through tax rebates; gave monetary grants and awards to companies openly trafficking fentanyl; holds ownership interest in several companies tied to drug trafficking; fails to prosecute fentanyl and precursor manufacturers; allows the open sale of fentanyl precursors and other illicit materials on the extensively monitored and controlled internet; censors content about domestic drug sales, but leaves export-focused narcotics content untouched; and strategically and economically benefits from the fentanyl crisis. The report finds that the U.S. should establish a Joint Task Force-Counter Opioids; provide law enforcement and intelligence officials with the statutory authorities, tools and resources needed; strengthen U.S. sanctions authorities; enact and use trade and customs enforcement measures; and close regulatory and enforcement gaps exploited by money launderers and fentanyl traffickers.

Source: Select Committee Unveils Findings into CCP’s Role in American Fentanyl Epidemic – REPORT & HEARING (The Select Committee on the CCP)

FDA issues marketing denial orders for 65 disposable vapes

The Food and Drug Administration (FDA) issued marketing denial orders to Shenzhen Yibo Technology Co. Ltd. for 65 disposable e-cigarettes marketed as MNGO Disposable Stick. The products include flavors such as tobacco, menthol, pink lemonade, strawberry mango, watermelon freeze, iced banana and others, with each flavor offered in a range of nicotine concentrations from 2% to 6%. The denial orders also include several “Clear” flavor products that were described by the applicant as flavorless or unflavored. However, data submitted in the company’s applications showed the products contained ingredients that are flavor enhancers or are known to impart a menthol or mint flavor, and the FDA determined that the products have a characterizing flavor.

Source: FDA Denies Marketing for 65 “MNGO Disposable Stick” E-Cigarettes (Food and Drug Administration)

CDC report shows improved but lacking Medicaid coverage for tobacco cessation

The Centers for Disease Control and Prevention released a report analyzing state coverage for nine tobacco cessation treatments (nicotine patch, gum, lozenge, nasal spray and oral inhaler; bupropion; varenicline; individual counseling; group counseling) and seven access barriers (copayment, prior authorization, counseling requirement, stepped care therapy, duration limitations, annual limit on number of covered quit attempts, lifetime limit on number of covered quit attempts) for standard Medicaid enrollees. In 2022, a total of 20 state Medicaid programs provided comprehensive coverage (all 9 treatments), an increase from 15 in 2018. Only three states had zero access barriers, an increase from two. Although states continue to improve smoking cessation coverage and decrease access barriers in Medicaid, coverage gaps and access barriers remain in many states. State Medicaid programs can improve enrollees’ health and potentially reduce expenditures by providing barrier-free coverage of all evidence-based cessation treatments and by promoting this coverage to enrollees and providers.

Source: State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2018–2022 (Centers for Disease Control and Prevention)

Health systems and states moving to limit reporting to child welfare officials for babies born exposed to substances

Pregnant and postpartum women who use medications for opioid use disorder (MOUD) are often reported to welfare services for child abuse and neglect under legal mandate. But some hospitals are changing their response. Mass General Brigham announced that it will no longer report suspected abuse/neglect to welfare officials simply because a baby is born exposed to substances. Rather, a report will be triggered only if there is reasonable cause to believe the infant is “suffering or at imminent risk of suffering physical or emotional injury.” The approach reflects a growing consensus that punitive approaches lead to worse outcomes for parent and child and inflict disproportionate harm. Some other health systems have implemented similar protocols. A few states have revised laws to divert substance-exposed infants who are not under threat of abuse or neglect away from the child welfare system. Others have legislation pending that would shield mothers taking MOUD from child welfare investigations. The federal SAFE in Recovery Act would block states from requiring child welfare notification if the substance is taken in accordance with prescriber recommendation and there is no other reason to suspect imminent danger.

Source: Some hospitals are changing their response when babies are born exposed to drugs (CNN)

Ohio governor gets GOP support for public health initiatives by focusing on children

Many Republicans dismiss public health initiatives as government overreach, but Ohio Governor DeWine says he has a strategy to get conservatives to pay attention – focus on children. He said that it is hard to sell things on the basis of public health, but everyone wants to see kids do better. In his State of the State address, he announced initiatives aimed at improving the lives of children, using rhetoric that emphasizes traditional conservative values. He promoted safe sleep for infants, early education, mental health care, poison control and gun violence prevention, all without mentioning “public health.” He proposed legislation to ban flavored vaping and cigarettes. Ohio’s deeply conservative legislature has fought DeWine’s attempts to curtail tobacco use, including limiting the ability of localities to ban flavored vaping and preempting efforts to raise tobacco taxes. DeWine said the votes are not there for a higher tobacco tax but said he will try to pass the flavor ban, noting an obligation to protect children. He said in almost every case, the legislature has given him the funding that he has asked for for children’s programs.

Source: How Ohio’s GOP governor sells public health: Don’t call it that. (The Washington Post)

Issue brief explains how states are covering pre-release services for incarcerated individuals in Medicaid

KFF released an issue brief on Medicaid pre-release services for people who are incarcerated. The SUPPORT Act prohibits states from terminating Medicaid for individuals under 21 or former foster youth under 26 while incarcerated. The 2023 Consolidated Appropriations Act (CAA) requires Medicaid to cover medically necessary screenings (including for behavioral health), diagnostic services and case management for eligible youth in public institutions 30 days prior to release by 2025 and provides an option for states to provide services to juveniles pending disposition of charges. In accordance with the SUPPORT Act, the Centers for Medicare and Medicaid Services (CMS) issued guidance in 2023 on using 1115 waivers to support community reentry. Minimum services include case management to assess physical, behavioral health and health-related social needs; medications for addiction treatment with accompanying counseling; and a 30-day supply of prescription medications at release. CMS has approved waivers from California, Montana and Washington. The states offer a range of services to different populations. CAA 2024 requires states to suspend rather than terminate Medicaid for incarcerated individuals by 2026 and directs CMS to issue guidance on strategies to ensure access to and continuity of care for beneficiaries before, during and after incarceration.

Source: Section 1115 Waiver Watch: Medicaid Pre-Release Services for People Who Are Incarcerated (KFF)

Policy barriers and stigma prevent implementation of effective contingency management for stimulant use disorder

Research shows that contingency management is the most effective treatment for stimulant addiction, but it has not been widely implemented due to policy barriers and stigma. The largest implementation to date has been the Veterans Health Administration’s program. More research is needed to evaluate and improve the long-term efficacy of contingency management. It has received pushback due to moral concerns about paying people for refraining from harmful and illegal activity. Under current government fraud and abuse laws, a contingency management reward could be considered an illegal “kickback.” For grant recipients, the federal health department imposes a $75 annual limit per client, well below the scientifically established value of incentives required for effective contingency management. The Substance Abuse and Mental Health Services Administration said it is aware that the limit is “subtherapeutic” and is reviewing the matter of increasing it. Some states have gained approval to use federal funds to pay for contingency management as a Medicaid benefit and to evaluate its effectiveness at scale.

Source: Small gift cards can be a key tool to stop stimulant addiction, but stigma stands in the way (CNN)