The most important part of Trump's opioid crisis plan may be overturning an obscure decades-old rule

  • President Donald Trump on Thursday brought up an obscure, decades-old rule in his speech declaring the opioid crisis a “national public health emergency.”
  • The IMD exclusion rule limits federal aid for Medicaid patients looking to get long-term addiction treatment in facilities larger than 16 beds.
  • Trump can either overturn that rule entirely or help speed up the process through which states can get exemptions to the rule. But it’s unclear which way he will go.

President Donald Trump on Thursday declared the opioid crisis a “national public health emergency” and announced several initiatives to combat the problem.

That included addressing an obscure rule that the White House Opioid Commission called one of the most impactful measures that could be taken by the federal government.

“As part of this emergency response, we will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction,” Trump said in a speech Thursday.

The rule, known as the Institutions for Mental Diseases exclusion rule, prohibits using federal funds for Medicaid patients in residential mental health or substance-use disorder treatment centres that have more than 16 beds.

That stipulation keeps patients on Medicaid — the government program that covers more than 74 million Americans, including low-income people — from getting long-term treatment in some larger treatment centres. To get around the rule, states can request waivers, which are approved by the Centres for Medicare and Medicaid Services. Trump expressed an interest in getting these approved quicker than they are today.

“A number of states have reached out to us asking for relief, and you should expect to see approvals that will unlock treatment for people in need. And those approvals will come very, very fast. Not like in the past — very, very quickly.”

Deb Beck, the president of the Drug and Alcohol Service Providers Organisation of Pennsylvania, a coalition of drug- and alcohol-abuse prevention, addiction treatment, and education programs and providers, told Business Insider that addressing this rule is “single most important thing that the president could do.”

But Beck said that she’d like to see the administration take a different approach to the rule. She said that she’d like to see Trump get rid of the rule entirely, rather than issue waivers — the current plan — which allows for the expansion of treatment centres to people with Medicaid on a state-by-state basis.

The waivers can be limited, Beck added, restricting the amount of time patients can stay at the treatment centres, sometimes to 15 or 30 days. That might not be enough time for a recovering addict: Beck compared it to giving just a half a dose of an antibiotic, it won’t be enough to get better.

According to the National Institute on Drug Abuse, for residential as well as outpatient treatment, participation has to last at least 90 days to get positive outcomes.

If Trump were to eliminate the rule entirely, it could be a more permanent fix, cutting out the need for waivers altogether.

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