West Virginia’s current Section 1115 Medicaid demonstration titled, “West Virginia Creating a Continuum of Care for Medicaid Enrollees with SUD” was originally submitted and approved by the Centers for Medicare & Medicaid Services (CMS) in October 2017 to help WV combat the ongoing public health crisis of its high rate of drug overdose deaths in the country. The current waiver demonstration was developed to help increase the availability of SUD prevention and treatment services for Medicaid members, improve overall health and health outcomes, and improve the integration of physical and behavioral health. Currently, services under the waiver include Peer Recovery Support Services, Residential Treatment for Individuals with a SUD and Methadone Treatment.
Over the demonstration years, the waiver has increased member access to and utilization of SUD treatment services. As of April 2021, over 249,000 Medicaid members received SUD treatment since the implementation of the waiver. While the implementation of the current 1115 waiver has significantly increased access to SUD services, gaps in access to critical behavioral health services remain. While this may be attributed to the challenges posed by the COVID-19 pandemic, the State will seek authority to authorize 11 new services, expanding the demonstration to support individuals with a serious mental illness (SMI) in addition to SUD conditions.
1115 Waiver Renewal Application (2022)
The current 1115 Waiver Demonstration will be expiring on December 31, 2022. BMS is seeking to renew the section 1115 waiver for another five years. In addition to the current 1115 Waiver services, the State proposes to expand services offered under the demonstration to further enhance the continuum of care and will rename the waiver to “Evolving West Virginia’s Medicaid Behavioral Health Continuum of Care.” To review the draft 1115 waiver renewal application, please see the resources below.
Section 1115 Waiver Demonstration Extension Application
Section 1115 Waiver Demonstration Extension Abbreviated Public Notice
Section 1115 Waiver Demonstration Extension Full Public Notice