July 10, 2020: State Advocacy Update


The AMA and Michigan State Medical Society (MSMS) are applauding a new state effort to provide free naloxone to community groups and others, a move that will decrease fatal opioid-related overdoses. The program was announced June 29 by Joneigh Khaldun, MD, chief medical officer and chief deputy for health at the Michigan Department of Health and Human Services (MDHHS).

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"During the COVID pandemic, when states are facing budgetary challenges, this is a remarkable effort to help save lives," said AMA Immediate Past President Patrice A. Harris, MD, MA. "We are greatly concerned that the COVID-19 pandemic has made the drug overdose and death epidemic worse (PDF) because of increased isolation and reduced access to treatment and harm reduction services such as naloxone. We urge all states to follow Michigan's lead and make a similar commitment to expand access to naloxone." "MSMS appreciates the state's proactive leadership to ensure Michiganders have readily available access to naloxone, a safe, effective antidote for reversal of an opioid overdose," said MSMS President S. Bobby Mukkamala, MD, who also is chair-elect of the AMA Board of Trustees. "In 2018, Michigan experienced 2,036 deaths from opioid-related overdoses leaving families and friends heartbroken. Community-based naloxone distribution has been shown to save lives." The MDHHS announcement said naloxone distribution is available to "any community organization statewide, including substance use treatment providers, non-profits, harm reduction organizations, jails, first responders, local governments and small businesses." After reviewing distribution plans, approved organizations will receive as many as 12 naloxone kits by mail. "While this type of community-based program will save lives, physicians must also continue to do our part," Dr. Harris said. "As the nation's opioid epidemic now is being fueled by more deadly and illicitly manufactured fentanyl and heroin, it is more important than ever for physicians to prescribe naloxone to patients at risk of overdose."Learn more about the AMA's recommendations for physicians to prescribe naloxone.

On June 30, voters in Oklahoma narrowly approved a state ballot measure to expand Medicaid under the Affordable Care Act (ACA) to childless adults with incomes up to 133% of the federal poverty level. An estimated 200,000 people will become eligible for Medicaid beginning on July 1, 2021. Oklahoma is the 37th state to expand Medicaid and joins Idaho, Maine, Nebraska and Utah as the fifth state to adopt Medicaid expansion via ballot measure. Voters will also decide whether to expand Medicaid in Missouri via a ballot measure in August. Earlier this year, Oklahoma Governor Kevin Stitt withdrew a plan that would have expanded Medicaid effective July 2020 but retained a Section 1115 demonstration waiver proposal to implement work requirements and other restrictions on Medicaid expansion beneficiaries. Stitt has also requested federal Medicaid funding via a block grant. The AMA submitted comments on the waiver proposal opposing block grant funding, work requirements and other restrictions.

Georgia lawmakers have approved extending Medicaid coverage for postpartum care for six months following birth. The state previously covered postpartum care for two months after birth. The initiative is fully funded in the 2021 state budget. More than half of the births in Georgia are covered by Medicaid, and Georgia has one of the highest maternal mortality rates in the country. The AMA believes access to care during the postpartum period is critical to preventing pregnancy-related deaths and supports Medicaid coverage for 12 months postpartum. The AMA and the Medical Association of Georgia supported the bill.

The National Governors Association released a new issue brief highlighting policy and other options for states to take to increase access to care for those with a substance use disorder (SUD). The brief, "State Strategies to Support Access to Substance Use Disorder Treatment Services through the COVID-19 Pandemic," provides examples of promising state efforts and challenges in several areas, including:

  • The need to better understand and gather data on SUD provider access
  • Funding opportunities for states
  • How Medicaid can better support providers
  • Reducing barriers to care for those with a substance use disorder

The brief emphasized, "As it becomes increasingly apparent that the medical, economic and fiscal fallout from the pandemic may be felt for an extended period of time, the question arises as to how states will support continued access in the longer term."Read more about AMA recommendations to help patients with pain, those with an opioid use disorder and recommendations in support of harm reduction efforts. There are more than 35 states that have reports of increases in overdose and other concerns relating to the drug overdose epidemic.