HEALTH CARE FINANCING ADMINISTRATION

II. METHODOLOGY

• Drug abuse treatment expenditures have been estimated using the results of data surveys. Only direct treatment costs have been estimated, to the exclusion of costs associated with the treatment of drug-related conditions.



• Treatment costs reflect estimates of both the hospital and non-hospital treatment costs for Medicaid. Medicaid-eligible individuals requiring drug abuse treatment can receive all covered hospital and non-hospital services required to treat their condition. Medicaid drug treatment expenditures are primarily for care received in hospitals and in specialized (free-standing) drug treatment facilities.

III. PROGRAM SUMMARY

• Under current law, states must pay for the inpatient, outpatient, and physician services for eligible persons under Medicaid, and at the option of the states, clinic and rehabilitative services. The primary limitation on using Medicaid drug treatment is that is cannot pay for any recipients ages 22-64 in large, inpatient psychiatric facilities defined as Institutions for Mental Diseases (IMDs).



• Medicare-eligible individuals requiring drug abuse treatment can receive all covered hospital and some non-hospital services necessary to treat their condition. Treatment costs reflect estimates of only the Hospital Insurance (Part A) treatment costs for Medicare.



• Medicare primarily covers inpatient hospital treatment of episodes of alcohol or drug abuse, as well as some medically reasonable and necessary services in outpatient settings for the continued care of these patients. Treatments for alcoholism covered by Medicare include diagnostic and therapeutic services in both inpatient and outpatient settings. Medicare-covered treatments for drug abuse include detoxification and rehabilitation in an inpatient setting.



• Medicare generally will not cover exclusively preventive care, such as education and counseling, but rather pays for such services only as they relate to a specific treatment episode for alcohol or drug abuse.



• Medicare Part A drug abuse estimates have recently been revised based on an analysis of FY 1990 Medicare data conducted by the National Institutes of Health. All drug-related resources associated with the Health Care Financing Administration support Goal 3 of the Strategy.

IV. BUDGET SUMMARY

1997 Base Program

• The 1997 base program includes $320 million to support Medicare Part A ($60 million) and Medicaid ($260 million) treatment costs which supports Goal 3 of the National Drug Control Strategy.

1998 Request

• The FY 1998 drug control budget request for Medicare Part A is $70 million, an increase of $10 million over the FY 1997 enacted level. This increase is associated with increased numbers of Medicare-eligible individuals requiring drug abuse treatment. The FY 1998 drug control budget request alson includes $290 million for Medicaid support, an increase of $30 million over FY 1997 enacted levels. All funding is in support of Goal 3.

V. PROGRAM STATISTICS

Not available.

VI. PROGRAM ACCOMPLISHMENTS

Not available.