The Medicaid Expansion’s Unexpected Impact on Drug Abuse

When Governor Tomblin announced earlier this month that West Virginia would be expanding Medicaid as part of the Affordable Care Act, there was little said on how this move will positively impact the state’s substance abuse problem.

The Governor’s Advisory Council on Substance Abuse (GACSA) (created by Tomblin in 2011) estimated that there are over 150,000 West Virginians with substance abuse problems in need of treatment. Without appropriate intervention or treatment, people with substance abuse problems are more likely to be unemployed, commit a crime, be arrested or incarcerated, and even die young (West Virginia leads the nation in death by unintentional overdose among adults 18 to 45).  It should come as little surprise then that final recommendations from the GACSA included providing more options for intervention, treatment and recovery, earmarking additional funding for substance abuse treatment efforts, and an improved “after care” system for individuals in recovery. 

Fortunately, Medicaid expansion may be the unexpected solution to GACSA’s recommendations.  As a result of the expansion, between 91,500 and 130,000 additional West Virginians will be newly enrolled in Medicaid, many of whom will need substance or alcohol abuse treatment.  Although we don’t have specific data for West Virginia, other states like Virginia have estimated that over one-third of the newly eligible population will need mental health and/or substance abuse services. This could mean that upward of 44,000 West Virginians will gain access to much-needed substance abuse and mental health treatment as a result of Governor Tomblin’s decision to expand.

Untreated substance abuse is also an important factor in chronic health conditions, and those without insurance are at an even greater risk.  The side effects of being uninsured are well documented – increased rates of chronic illnesses like diabetes or hypertension, delayed access to treatment and medical care, decreased life expectancy, and ultimately increased mortality.  In addition, uninsured individuals are likely to delay seeking treatment which can greatly increase health care costs as patients require more complex, more expensive care.  Currently, there are nearly 260,000 uninsured West Virginians, including around 20 percent of residents 19 to 64.

Expanding Medicaid to insure more West Virginians may even save the state money in some other unanticipated ways too.  For example, improved access to substance abuse services has been shown to reduce the incarcerations due to drug-related offenses, which happens to be the leading cause of incarceration in West Virginia.

By choosing to expand Medicaid in West Virginia, Governor Tomblin has not only ensured improved access to health care and financial stability for tens of thousands of West Virginia families but has taken an important step in addressing the rampant substance abuse problem that’s hurting our state’s fiscal and physical health and crowding up our prisons.

Fixing Job Applications Could Help Ex-Felons Gain Employment

While the governor’s prison reform bill (SB 371) is being debated in the House, they might want to think about removing barriers that make it very difficult for ex-felons gain employment. If one of our goals is help reduce recidivism and help ex-felons enter the workforce, the state will need to end counter-productive practices that make it difficult for ex-felons to get a job. One way that this could be accomplished is if the state prohibited some employers from asking about convictions on job applications. So far, seven states and more than 40 cities nationwide have passed this reform which is often referred to as “ban the box.”

The “box” refers to the place on many employment applications that asks whether the applicant has been convicted of a crime or sometimes it may even inquire about arrests. By removing the box from applications, it would give the employer the opportunity to learn about the candidate’s experience and skills as they relate to the position instead of automatically tossing out the application. However, this does not mean that the employer cannot run a criminal background check. The aim is to help remove this initial barrier and allow the applicant to explain his or her record and how successful their rehabilitation efforts have been since being convicted.

If we want to reduce our growing prison population, reduce prison costs, and help families of formerly incarcerated heal, prosper and contribute to our community, then ex-felons must have a better shot at getting a job.  While the legislature may not look at “banning the box” this year, cities in the state could lead the way and put pressure on the state to do the same.