Trump Opioid Declaration Unsatisfactory, Say US Governors

Megan Brooks

October 30, 2017

Last week, President Donald J. Trump declared the opioid crisis a public health emergency, not a national emergency, as his own special commission had urged in July.

The National Governors Association (NGA) believes the declaration falls short.

"We believe it's a step in the right direction. Highlighting the opioid crisis through the president's voice is obviously very important. The governors have been trying to do that through their voices since 2012," Hemi Tewarson, director of the NGA's Center for Best Practices Health Division, said during a media briefing today.

"But this effort does not have federal funding associated with, and from a state's perspective, federal funding would certainly be helpful, because in order for efforts to be successful, there also needs to be funding behind it. That obviously is a piece that was not accomplished by this declaration," said Tewarson.

President Trump's declaration "didn't satisfy everyone, including us, but I think it was an important first step," added Anna Davis, director of the NGA's Office of Government Relations. "What it did not do was unlock significant new resources for states or federal agencies to aid in the response."

Tewarson said one action that will be taken under the declaration is the expansion of medication-assisted treatment via telemedicine, "which is of interest to the states." Telemedicine is an area where "we can really start to make a difference," added Davis, particularly in hard-hit rural areas of West Virginia.

Beyond the declaration itself, the president has also pledged that the states will receive expedited approval of waivers for the Medicaid Institution for Mental Diseases (IMD) exclusion, Tewarson noted. The Medicaid IMD exclusion prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities that have more than 16 beds.

The IMD waiver is "something the governors say they need. It means they could provide some inpatient residential treatment for individuals suffering from the opioid crisis, and states have told us they need more flexibility to do that and need Medicaid payments to support that," Tewarson said.

The IMD waiver is also "one of the strategies that have been highlighted in draft recommendations from the President's Commission on Combating Drug Addiction in the opioid crisis. It is also a topic that a number of governors and their staff have raised with us here at NGA and that we have included in our priorities," Tewarson said.

"Since 2012, governors have taken the lead in addressing the emerging opioid crisis in their states. In 2016, 46 governors signed the Compact to Fight Opioid Addiction and committed to redoubling their efforts to end the crisis. This marked the first time in more than 10 years that the governors came together through NGA to develop a compact on an issue of national importance," he added.

Davis said the President's Commission on Combating Drug Addiction is expected to release its final report this week. Three of the commission members, including the chair of that commission, are governors. "That is really critical, because the governors can really provide a look at what is happening in the states and identify the tools that are needed to really have an impact," she said.

"This is a problem that is not going away, and we need to find new tools and ways to work together, and I think the governors can be at the forefront of those actions," Davis added.

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