Illinois Governor Vetoes Heroin Bill Over Medicaid Treatment Funding [FEATURE]

Faced with a public health crisis related to heroin and prescription opioid use, the Illinois state government created a bipartisan Heroin Task Force in a comprehensive effort to address the problem from all angles. The task force created a set of policy recommendations that were embodied in House Bill 1, the Heroin Crisis Act.

The bill passed the House and Senate in May, and was sent to Gov. Bruce Rauner (R) in June, where it sat on his desk until this week. On Monday, Rauner finally acted -- not by signing the bill, but by vetoing critical sections of it that he says the state cannot afford. He has now sent the bill back to the legislature and asked it to remove the offending sections.

But saying, "People are dying," the measure's House sponsor, Rep. Lou Lang (D-Skokie), has vowed an effort to override the veto. An override could be within reach -- the bill passed by veto-proof majorities in both houses -- but for members of a governor's own party, a veto override is a hard vote to take.

Here's what the bill does:

• It increases the availability of opiate overdose reversal drugs and requires private insurance to cover at least one of them, as well as acute treatment and stabilization services. It allows licensed pharmacists to dispense overdose reversal drugs, allows school nurses to administer them to students suffering from overdoses, and provides protection from civil liability for people who administer them in good faith.
• It requires the Department of Human Services and the State Board of Education to develop a three-year pilot heroin prevention program for all schools in the state, requires the Department of Human Services to develop materials to educate prescription opiate users on the dangers of those drugs, and it requires the Department of Insurance to convene working groups on drug treatment and mental illness and on parity between state and federal mental health laws.
• It intensifies the state's prescription monitoring program by tightening reporting requirements and it requires doctors to now document the medical necessity of any three sequential 30-day prescriptions for Schedule II opioids.
• On the criminal justice front, it permits multiple chances at drug court and prevents prosecutors from unilaterally blocking entry to drug court, and it requires prosecutors and public defenders to undergo mandatory education on addiction and addiction treatment. It also increases criminal penalties for "doctor shopping" if fraud is involved.
• It requires Medicaid coverage of all heroin treatment, including methadone and other opiate maintenance treatment, as well as all anti-overdose medications.

It's the latter provision to which Rauner objects.

"I support all of the above measures and applaud the multifaceted approach to combating this epidemic in Illinois. Unfortunately, the bill also includes provisions that will impose a very costly mandate on the State's Medicaid providers. I am returning the bill with a recommendation to address that concern," he said in a veto statement.

"House Bill 1 mandates that fee-for-service and medical assistance Medicaid programs cover all forms of medication assisted treatment of alcohol or opioid dependence, and it removes utilization controls and prior authorization requirements," Rauner continued. "These changes would limit our ability to contain rising costs at a time when the State is facing unprecedented fiscal difficulties. Importantly, the State's Medicaid programs already cover multiple forms of medication necessary to treat alcohol and opioid dependence. But without adequate funding to support mandated coverage for all forms of treatment, regardless of cost, this change would add to the State's deficit."

His recommendation is simply to delete the language requiring Medicaid coverage.

Rep. Lang and other bill supporters aren't going for that.

"There's a human cost to not doing it," Lang said. "People are addicted, people are sick, people are dying. You want to talk about the costs of providing methadone and Narcan to addicts, but you forget totally that if you cure them or they get off the stuff, there's a savings to the Medicaid system on a different line item, because they're no longer in emergency rooms, they're no longer a burden to law enforcement."

Heroin and opiate addiction is a serious problem in Illinois. The rate of drug overdose deaths has nearly doubled since 1999, and in the Chicago suburbs, people have been dying of drug overdoses at a rate of three per day since 2012. In the state as a whole, 633 people died of heroin overdoses last year, with nearly half (283) in Chicago.

At the same time as the problem with heroin and prescription opioids has been deepening, the state's ability to provide treatment has been decreasing. According to a report this month from the Illinois Consortium on Drug Policy, the state's ranking for drug treatment capacity has fallen from 28^th in the nation in 2009 to 47^th this year. This as demand for heroin and opiate treatment statewide is increasing dramatically. In Chicago and the surrounding suburbs, 35% of drug treatment admissions are for heroin, more than twice the national average.

The consortium's director and the study's lead author, Kathleen Kane-Willis, noted that Illinois is one of only a few states nationwide that doesn't allow Medicaid coverage of opiate maintenance treatment.

"We're going to pay for not paying," she said.

But bill supporters could also find the votes to override the veto. Rep. Lang says that is what's he going to try to do, and with a 114-0 vote in the House and a 46-6 vote in the Senate the first time around, he has plenty of supporters to ask. If that happens, Illinois will get the drug treatment it needs, and Rauner will still be able to maintain his fiscally conservative credentials.