News & Updates — Program Brief

Since 2022, FORE’s Family- and Community-Based Prevention Program has supported the development and delivery of services that strengthen families impacted by opioid and other substance use disorders (OUD/SUD) and mitigate the risks of adverse childhood experiences and substance use among the millions of U.S. children affected by a parent’s or caregiver’s OUD/SUD. As a source of healthcare coverage and financing for half the nation’s children and largest source of coverage for behavioral health services, including OUD/SUD treatment, Medicaid along with the Children’s Health Insurance Program (CHIP) may provide routes to sustaining this whole-family approach to OUD/SUD prevention.

A FORE-supported analysis from Manatt Health published today highlights ways states can leverage existing authorities under Medicaid and CHIP to sustain innovative prevention programs that support and treat children and families impacted by OUD/SUD.

The report shows that states have broad flexibility to define what services they cover and in what settings, including schools, community-based organizations, hospitals, and health clinics. State Medicaid programs are also required to pay for all diagnostic and treatment services deemed medically necessary for children and youth under the age of 21 who meet eligibility requirements, per the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions.

To help readers navigate an array of coverage pathways, the authors looked at how seven FORE grantees could leverage state plans, waivers, and other authorities to cover evidence-based prevention, treatment, and case management services, as well as provider training. In detailing the mechanisms for financing these prevention services for low-income children and families, the report provides a roadmap of steps programs and providers can follow to secure reimbursement.