The State of Montana is grappling with a serious and growing public health problem in substance use disorders (SUDs)—including alcoholism, methamphetamine use and opioid abuse and overdose—as well as the related, profound economic and social consequences of these conditions. Montanans have particularly high rates of alcohol dependence and abuse, and more than 90 percent of those with alcohol or drug problems do not receive treatment. Across the State, alcohol and drug abuse consistently top the list of health concerns identified in community assessments, indicating widespread agreement about the urgent need to address these issues. Even as Congress and the Administration consider broad changes to healthcare reforms implemented under the Affordable Care Act, including elimination of Medicaid expansion and deep cuts to federal Medicaid funding, Montana’s Medicaid program has a unique, point-in-time opportunity to make meaningful progress in SUD delivery system and payment policy to improve the health, well-being and lives of Montanans.

In a new report for the Montana Healthcare Foundation, Manatt Health explores Medicaid’s new role as the primary payer for SUD services in Montana as a direct result of the 2016 Medicaid expansion to cover most low-income adults in the State. The report lays out strategies that the Montana Medicaid program may pursue in this new role to improve SUD service delivery.