The Senate approved the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act’’ or the ‘‘SUPPORT for Patients and Communities Act’’ or HR 6 on Wednesday, October 3 by a vote of 98 to one. The lone vote was by Senator Mike Lee (R-UT) with Senator Ted Cruz (R-TX) not voting. The House approved the measure the week before.

The legislation continues the influx of increased drug treatment funding first allocated in late 2016 and adds a number of other smaller provisions and continue the more than $1 billion influx in treatment dollars. Overall the legislation is paid for with changes in Medicaid and Medicare to address other changes in those programs and others.

The bill affects any number of departments, agencies, funding sources and programs. It includes fixes in Medicaid for youth exiting foster care and in juvenile justice, it includes amendments to CAPTA to help allocate the new $60 million in CAPTA funding already included in the FY 2018 and FY 2019 appropriations; includes instruction on how an additional $20 million for regional partnership grants under Title IV-B will be spent (also included in the FY 2019 appropriations), and provides an additional $15 million for a foster care reunification program that has shown promise.

The legislation includes two fixes to Medicaid in relationship to youth involved with juvenile justice and foster care:

One House-originated section requires state Medicaid programs to suspend and not end a juvenile’s Medicaid eligibility when s/he is incarcerated. A state may suspend coverage while an inmate, but they must restore coverage after a release and not required a new application. The practice has had the effect of eliminating Medicaid coverage to youth exiting juvenile justice.

Another House-generated proposal would fix a technical problem with the ACA regarding youth that exist foster care, but the provision will not take effect until 2023. States will be required to ensure that former foster youth are able to keep their Medicaid coverage across state lines until the age of 26. The ACA mandates this coverage for youth that aged out of care but because of technical problem with the way the law was written it had been interpreted by HHS as only applying to the state the young person way residing in while in foster care. States must adopt the policy in calendar year 2023 for individuals attaining the age of 18 that year but may adopt the policy sooner. At present states have the option to extend this protection.

The foster youth Medicaid fix did not take immediate effect because, as is the curse of almost all child welfare legislation, Congress did not want to pay for the projected $20 to $30 million a year costs so the delay pushes it outside of the five-year budget window.

The child welfare provisions:

HHS is to assist states in instruction and guidance on how to use Medicaid and IV-E funding for treatment/placements that allow a child to be placed with a parent in family-based substance abuse treatment. As of October 1, 2018, states can make foster care maintence payments to a facility on behalf of a foster child in a placement with the parent. The provision applies regardless of whether the foster child is covered by federal foster care income eligibility restrictions. The bill also allocates an additional $20 million in FY 2019 for funding projects to develop family-based treatment facilities (already provided in the new FY ’19 just signed). Funding will be a part of the regional partnership grants (RPGs).

$15 million in mandatory funds are allocated to strengthen research based on an Illinois state waiver project that focused on reunification services involving recovery coaches and other intensive family-focused services. If further developed and proven, it could serve as a program that could be funded as a “well-supported” program under the Family First Act.

Other parts of the legislation that could serve child and child welfare go to last week’s

Children’s Monitor under House and Senate Agrees to Opioids Legislation.