SUPPORT for Families and Communities Act: New Funding and Flexibility for States to Address Substance Use Disorder

Last week, Congress sent the SUPPORT for Patients and Communities Act, a wide-ranging bill that seeks to address the country’s opioid crisis across a number of policy areas, to the President for his signature. The act contains numerous provisions that affect how state Medicaid agencies structure and administer services and supports for individuals with opioid and other substance use disorders (SUD).

Medication-assisted treatment (MAT) emerges as a central strategy, and the act gives states some flexibility to expand SUD service delivery using Institutes for Mental Disease (IMDs). A number of provisions also address the impact of SUD on pregnant women, infants, children, and youth. The table below highlights some of the act’s key provisions affecting state Medicaid programs.

Requires states to cover children in foster care up to age 26 and to suspend eligibility for juvenile justice-involved youth (Sec. 1001, 1002) By calendar year 2023, states must provide former foster care youth with Medicaid coverage up to age 26, regardless of what state they lived in when they aged out of the foster care system. Currently, Medicaid must cover youth up to age 26 within the state the youth aged out of foster care, and states have the option to cover youth who age out of another state’s foster care system. For youth engaged in the criminal justice system, the act requires states to suspend, rather than terminate, Medicaid coverage while these youth are incarcerated, and to restore their Medicaid coverage upon their release, without completing a new application, unless they no longer meet eligibility requirements.
Creates a demonstration program to expand SUD treatment

(Sec. 1003)

The act creates a new demonstration program to improve capacity for SUD treatment services, with a particular focus on MAT, neonatal abstinence disorder, pregnant and post-partum women, and adolescents. Ten states will receive planning grants, and of those states, five will be selected to receive enhanced  federal match for SUD treatment and recovery services.
Additional requirements for Medicaid drug utilization review

(Sec. 1004)

By October, 2019, states will be required to have safety edits and automated review processes in place to avoid prescription abuse, monitor and report on antipsychotic medication prescribing to children, and identify fraud and abuse by Medicaid enrollees, providers, and pharmacies.


Extends SUD health home enhanced match to 10 quarters

(Sec. 1006)

For health home state plan  amendments  approved on or after Oct.  1, 2018, the act  extends enhanced Federal Medical Assistance Percentages (FMAP) funding to states from eight quarters to ten.
Requires MAT to be included in state plans

(Sec. 1006)

From Oct. 1, 2020 to Sept. 30, 2025, states will be required to include MAT services in their state plans. States may certify that implementing the provision is not feasible due to a shortage of qualified providers or facilities to provide MAT.
Changes in Institutions for Mental Disease coverage

(Sections 1012, 1013, 5052)

  • Permits states to pay for services delivered outside of an IMD to pregnant/postpartum while they are receiving SUD treatment in an IMD facility.
  • Creates a temporary state plan amendment option period (Oct. 1, 2019 to Sept. 30, 2023) that permits payment for  IMDs for up to 30 days within any 12-month period for Medicaid beneficiaries. Maintenance of effort is required by states for both IMD and outpatient SUD services. States must demonstrate that they have a full continuum of SUD services available.
  • Clarifies that states may pay capitation rates to managed care plans for enrollees receiving  treatment in an IMD.
Clarifies payment for treatment at residential pediatric recovery centers

(Sec 1007)

Permits states to pay for inpatient or outpatient services, including counseling for parents, at residential pediatric recovery centers that treat infants with neonatal abstinence syndrome.
Strengthens prescription drug monitoring programs

(Sec. 1944)

Starting October 2021 , states must require Medicaid providers to check patients’ prescription drug history before prescribing controlled substances. The act allows for enhanced FMAP to states for expenditures to design, develop, or implement a prescription drug monitoring program that meet the act’s requirements.
Changes Medicaid managed care medical loss ratio

(Sec. 4001)

Permits states to receive an enhanced share of remittances from Medicaid managed care plans that do not meet the minimum medical loss ratio of 85 percent.
Mandates reporting on adult behavioral health measures

(Sec. 5001)

Beginning with the state report for 2024, states will be required to report on all behavioral health measures included in the adult core measure set.
Extends mental health parity to Children’s Health Insurance Programs (CHIP)


Requires all state CHIP programs to include coverage of mental health services, including behavioral health treatment. The provision explicitly notes that the requirement for these comprehensive services applies to both children and pregnant women regardless of the type of coverage (including separate CHIP programs) that a state has selected to operate.