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Agency Budget Summary
Department of Health and Human Services
Health Care Financing Administration
I. Resource Summary
II. Methodology
- Medicaid 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.
- 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. Medicare Part B drug abuse treatment estimates cannot be developed at this time, because procedure codes do not permit identification of drug-related claims.
III. Program Summary
Medicaid
- 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.
- Under current law, States must pay under Medicaid for the inpatient, outpatient, and physician services for eligible persons, and at the option of the States, clinic and rehabilitative services. The primary limitation on using Medicaid drug treatment is that it cannot pay for any recipients aged 22-64 in large, inpatient psychiatric facilities defined as Institutions for Mental Diseases (IMDs).
Medicare
- 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.
IV. Budget Summary
1999 Program
Goal 3: Reduce health and social costs to the public of illegal drug use.
- The FY 1999 enacted drug control budget for Medicare Part A is $10.0 million over the enacted FY 1998 level. This increase is associated with increased numbers of Medicare-eligible individuals requiring drug abuse treatment. The FY 1999 drug control budget also includes $320.0 million for Medicaid recipients, an increase of $30.0 million over FY 1998 levels. All funding is in support of Goal 3.
2000 Request
Goal 3: Reduce health and social costs to the public of illegal drug use.
- The total drug control request for Goal 3 activities for FY 2000 is $450 million, a net increase of $50 million over FY 1999. The FY 2000 request reflects continued programmatic growth in the Medicaid and Medicare programs.
- The FY 2000 drug control budget request includes $360 million for the Medicaidprogram, and increase of $40 million over FY 1999 enacted levels. All funding is in support of Goal 3.
- The FY 2000 enacted drug control budget for Medicare Part A is $90 million, an increase of $10 million over the FY 1999 enacted level. This increase is associated with increased numbers of Medicare-eligible individuals requiring drug abuse treatment.
V. Program Accomplishments
- The Health Care Financing Administration continues to meet the challenges of providing drug abuse treatment care to eligible Medicare and Medicaid patients.
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