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Authors Posts by Jason Snyder

Jason Snyder

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Governor Shapiro and Pennsylvania are listed along with 22 other plaintiffs in a lawsuit filed in US District Court in Rhode Island, requesting an emergency temporary restraining order against US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. for abruptly terminating COVID-grant funds, including a supplemental to the Substance Use Disorder Block Grant, that were appropriated for use for states until September 30, 2025.

Though not confirmed, media reports suggest the termination of grants could cost the Pennsylvania Department of Health $301 million, along with an additional $28 million or more hit against the Pennsylvania Department of Drug and Alcohol Programs (DDAP).

DDAP had been using these grant funds to expand testing and provide resources for COVID; support providers and help meet local needs during the pandemic; and expand the substance use disorder prevention, intervention, treatment, and recovery support services continuum, including various evidence-based services and supports for individuals, families, and communities.

DDAP is examining its options to maintain the full array of services offered by single county authorities and their providers to ensure Pennsylvanians continue to receive the lifesaving supports they need.

The factual allegations and legal background in the lawsuit state that during the COVID-19 pandemic, Congress appropriated substantial funds to strengthen public health programs that were not tied to the duration of the public health emergency. HHS and Congress continued to make these public health funds available after the end of the pandemic.

On Monday, March 24, with no advance notice, HHS abruptly terminated $11 billion in grants and cooperation agreements funded by appropriations from COVID-related laws. States were notified through letters from the Substance Abuse and Mental Health Administration (SAMHSA). The letters indicated the grants were issued for a limited purpose: to ameliorate the effects of the pandemic. The end of the pandemic provides cause to terminate COVID-related grants. Now that the pandemic is over, the grants are no longer necessary.

The lawsuit goes on to state the terminations have caused and will continue to cause irreparable harm and asks the court to vacate and set aside the termination of the funding and any other further actions taken by US HHS to implement or enforce them, among other requests.

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There are many stakeholders in the broad substance use disorder (SUD) landscape who are nervous about how US Department of Health and Human Services Secretary Robert F. Kennedy Jr. will steer policy. But from a treatment perspective, given his beliefs and experiences, he could drive significant improvement in the way those Americans who suffer most severely from SUD are treated.

In January, after President Trump took office and nominated Kennedy to be secretary, many SUD treatment providers and advocates, along with several media outlets, immediately raised concerns. Pointing predominantly to the 45-minute documentary Kennedy made as part of his early campaign for the presidency, some advocates feared that if he was confirmed as secretary of HHS, he would use his personal experience and preferences to unduly influence the country’s SUD treatment policy away from evidence-based treatment, including the use of medications like methadone and buprenorphine.

In “Recovering America – A Film About Healing Our Addiction Crisis,” Kennedy, who is in long-term recovery from heroin addiction, featured “healing farms” – a form of therapeutic communities – as successful models for treating SUD. Therapeutic community is a treatment approach built on the premise that for recovery to occur, a change in lifestyle and social and personal identity is vital. He said that if he was elected president, he would open hundreds of healing farms across the country.

Of course, he did not become president, but he was confirmed as secretary of HHS in February.

Kennedy’s support of healing farms is not the only concern of some advocates. The pathway to his own recovery – a 12-step program – and his staunch support and continued participation in that program, which many criticize for its abstinence-only philosophy, including its rejection of medications to treat SUD, is also a red flag.

An Opportunity to Improve What Already Exists

But Kennedy actually has an opportunity to leverage his experience and philosophies in a way that improves the predominant residential treatment model in place today for those with the most severe and advanced disease. This does not mean a wholesale shift toward healing farms or even therapeutic communities (though in a world of individualized care and personal choice, there can be a place for these types of treatment models). It should, however, include policy that forces increased funding of residential treatment settings, in order to provide adequate lengths of stay and meaningful integrated mental and physical health and recovery support services throughout the continuum – including, when necessary, skilled nursing facilities that accept patients whose treatment includes narcotic medication, and appropriate, safe, and accessible recovery housing. A stronger continuum of care for those suffering the most severe SUD can enable social connectedness, sense of community, belongingness, and meaning and purpose. Not only are these foundational goals of therapeutic communities and values Kennedy holds in high regard; they are also key tenets of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) working definition of recovery. As HHS secretary, Kennedy oversees SAMHSA.

In Kennedy’s documentary, he walked the streets of San Francisco and showed footage of Philadelphia’s Kensington neighborhood. Living in the age of fentanyl and xylazine, the individuals from these streets who make it to treatment are typically homeless, have extreme physical comorbidities, and have suffered unimaginable trauma and mental illness. In other words, they are the most ill. Yet, in Pennsylvania, we often see an aggressive push by payers to quickly move them from the highest levels of care, where patients whose acute biomedical, emotional, behavioral, and cognitive problems are so severe that they require primary medical and nursing care, to lower levels of care well before their clinicians believe they are ready.

Many policymakers, pundits, and payers will point to the high cost and lack of evidence to support such lengths of stay in residential settings. But any argument that the research does not support long-term residential treatment should be carefully scrutinized, in particular because little research exists that examines outcomes for those with the most severe SUD. If Pennsylvania policymakers and payers have such data, they should bring it forward.

Ensuring and Improving Access to Medication

What is indisputable is the fact that medications to treat opioid use disorder not only reduce overdose deaths, but they also increase engagement and retention in treatment, increase abstinence from opioid use, and improve other quality-of-life metrics.

But Kennedy’s position on several other issues has advocates concerned about his position on medications like buprenorphine and methadone.

From within the mental health and SUD advocacy world, one of the strongest endorsements Kennedy received ahead of his confirmation was from his cousin Patrick Kennedy, a former US Congressman from Rhode Island and staunch SUD and mental health advocate who has been in recovery 14 years. Patrick Kennedy’s treatment and recovery path included the use of buprenorphine and naltrexone, as well as medications to address mental health.

In a 2016 story in the Seattle Times, Patrick Kennedy said, “We’re hogtied because many of those influencing addiction policy in this country come from the 12-step culture, which says abstinence is the only true form of recovery. We’re losing a lot of people on the altar of that type of rigid ideology.”

Even closer to home, Robert Kennedy experienced the death of his younger brother David, whom he described as his best friend. David Kennedy was 28 years old when he died in 1984. My younger brother Todd was 28 years old when he died in 2005 from a heroin overdose. Less than two years later in September 2007, my 25-year-old brother Josh, the youngest of my parents’ three children, died of a drug overdose. I have often said that my parents, both of whom I am grateful to still have today, would much rather have their two dead sons alive and using buprenorphine or methadone, with a chance to define their own lives and recovery, than lying side by side in a graveyard in Cambria County, PA. I can’t imagine that Robert Kennedy feels any different about David – that if there was something that could have been done to give him another day and a shot at recovery, he would have staunchly supported it. In preserving and enhancing access to medications, Kennedy has the opportunity to give to parents, siblings, and other family members and loved ones what he and I no longer have.

Walking the Tightrope

In my work, a key component of advocacy on behalf of SUD treatment and those who need it is an ability to put aside my own recovery path, and acknowledge and support other pathways that I might not choose but can nonetheless be effective. In fact, this is in large part what a professional peer does. And for Kennedy, as evidenced by his documentary, the peer is an indispensable, integral part of the recovery process; not just in the healing farm setting, but in justice-system diversion programs as well, for example.

Related to my recovery from SUD, if you want the type of life I am striving to live and want to know what I do, I am willing to show you. My professional role, however, does not include forced imposition of my personal philosophies on you. To find such a balance requires open-mindedness, which is also a bedrock principle of the Alcoholics Anonymous (AA) program Kennedy lives. The challenge with open-mindedness is applying it in all of life, not just within the parameters we choose to live. In doing so, we potentially attract others to that lifestyle.

Kennedy obviously is not simply an advocate or a well-known “old-timer” in a local area of AA meetings. He is the top policymaker for HHS and SAMHSA. From the highest, most influential platform he has ever had relative to his recovery, he can strike the right balance.

With a better funding approach, Kennedy can infuse aspects of a treatment modality and recovery support program that has worked for many, including himself, into the system we have in place today. In doing so, he can improve treatment broadly for those with the most severe SUD, and support and advance the integral, life-saving role medications play, all while serving as a role model for what recovery may look like for some.

For the sake of all of those who are still suffering from this disease, including families, I hope he can do it.

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The U.S. Department of Health and Human Services (HHS) announced yesterday that the public health emergency declaration addressing the nation’s opioid crisis has been renewed, allowing sustained federal coordination efforts and preserving key flexibilities that enable HHS to continue leveraging expanded authorities to conduct certain activities in response to the opioid overdose crisis.

The public health emergency, first declared under President Trump in 2017, was set to expire on March 21, 2025. The renewal extends the emergency for 90 days.

More information about the declaration is available on the Substance Abuse and Mental Health Administration’s (SAMHSA) website.

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The 2025 American Association for the Treatment of Opioid Dependence (AATOD) Conference will be held October 4 – 8 in Philadelphia at the Philadelphia Marriott Downtown. The 2025 conference theme is “The Evolving Field of Opioid Treatment.”

Early registration is open now through June 30. Register here.

The aim of the conference is to educate and promote acceptance and integration of medication-assisted treatment options by patients, families, clinicians, the medical system, judicial systems, government, policymakers, social service administrations, and the general public. Presenters will disseminate innovative, evidence-based initiatives and treatment techniques to better serve patients and providers, improve program development and administration, promote integration across the continuum of care, and enhance patient outcomes to assist communities in developing an effective response to this crisis.

The Pennsylvania Association for the Treatment of Opioid Dependence (PATOD), the state chapter of AATOD, is a member of RCPA. RCPA member Josh Nirella, Regional Director for Acadia’s Comprehensive Treatment Centers, is Conference Chair. RCPA member Pam Gehlmann, Regional Director for Pinnacle Treatment Centers, is Host Committee Chair.

More information is available on the 2025 AATOD Conference website.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) today issued Licensing Alert 01-2025 to update statewide exceptions granted to narcotic treatment programs (NTP) in September 2024 to expand access to medication for the treatment of opioid use disorder (MOUD). Specifically, this alert expands the exceptions to allow expanded use of telehealth in initial screening and physical examinations consistent with medical practice regulations of the State Board of Medicine.

Effective December 21, 2024, the State Board of Medicine amended its regulation regarding prescribing, administering, and dispensing controlled substances. The updated regulation mirrors federal regulations by allowing regulated practitioners in NTPs to conduct initial physical examinations by telehealth and initiate treatment with buprenorphine or methadone in compliance with federal requirements and requires an in-person physical examination to be completed within 14 days after admission. Therefore, DDAP is also granting an exception to 28 Pa. Code § 715.9(a)(4), which is the rule that requires a face-to-face determination be made as to whether a person has been dependent on a narcotic drug for at least one year prior to starting MOUD, provided that the NTP has a trained person to diagnose the client using medical criteria in accordance with 42 CFR § 8.12(e)(1) and documents the reason for admission for MOUD treatment in the record. DDAP will allow telehealth for the initial screening and medical examination provided that the clinician determines that they can complete an adequate examination through that method, that the mode of telehealth is permissible for the MOUD to be used in accordance with 42 CFR 8.12(f)(2)(v), and that the NTP completes a full in-person physical examination within 14 days of admission in accordance with 42 CFR 8.12(f)(2)(iii).

DDAP first granted statewide exceptions based on 42 CFR part 8 through Licensing Alert 07-2024. Today’s Licensing Alert 01-2025 rescinds and replaces Licensing Alert 07-2024.

Federal regulations continue to require NTPs and clinicians to comply with pertinent state laws and regulations.

To review all of the exceptions DDAP is granting NTPs, read Licensing Alert 01-2025.

There is no need for NTPs to submit exception requests or to inform the DDAP if they are using these exceptions.

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Pennsylvania’s single county authorities (SCA), in collaboration with the Department of Drug and Alcohol Programs (DDAP), developed a new rate-setting package (i.e., XYZ Package) for residential providers to submit cost-based rate requests for Fiscal Year 2025/26.

The deadline to submit the rate package has been extended to Monday, March 24. This change is reflected in the package itself, which, along with a training video for how to complete the new package, is available on the PACDAA website.

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The Republican-controlled U.S. House adopted a federal budget resolution last week that instructs the House Energy and Commerce Committee, which has jurisdiction over Medicaid, to identify at least $800 billion in mandatory spending cuts during the next 10 years. The resolution is now in the GOP-controlled U.S. Senate.

Medicaid, which is jointly funded by states and the federal government through a federal matching program with no cap, is seen as a prime target for cuts, as it is one of the largest federal programs at a cost of more than $600 billion a year. Approximately 70 million people in the United States receive Medicaid benefits, with about 3 million — including 1.2 million children — of those in Pennsylvania. While officially the federal government did not name Medicaid as the target, there are virtually no other areas to turn to in order to generate such spending cuts.

Proposals being considered in Congress to cut Medicaid are estimated to cost Pennsylvania as much as $2 billion a year. These cuts will inevitably result in:

  • Fewer insured Pennsylvanians;
  • Fewer covered services for those who remain insured;
  • Lower reimbursement rates paid to providers;
  • Increases in uncompensated care; and
  • Higher healthcare costs for those who are insured.

In addition to broad, negative consequences, each segment of the human services sector will be affected.

Behavioral Health

Medicaid is the largest payer of behavioral healthcare services in the United States, where nearly 40 percent of non-elderly adult Medicaid beneficiaries have a mental health or substance use disorder. Additionally, Medicaid is an essential revenue source for behavioral healthcare organizations. With the potential of fewer covered individuals and lower reimbursement rates, access will be squeezed, with existing providers less incentivized to accept Medicaid patients.

These potential cuts come on the heels of a compromised post-public health emergency unwinding of Medicaid, in which Pennsylvania’s actuarial analysis for the behavioral health capitation was severely underestimated. The eventual Medicaid rolls included more individuals with acute and chronic conditions, resulting in higher levels of care and services. Despite mid-year adjustments to the HealthChoices’s primary contractors, Pennsylvania will start the new fiscal year with the need to increase its BH Medicaid capitation by nearly $640 million.

Intellectual and Developmental Disabilities

Medicaid is the primary funding source for IDD services. If the proposed multi-billion dollar funding cuts occur, Pennsylvania’s intellectual disability system will face serious consequences, including service reductions, longer waitlists, and limited access to essential care. Providers already under strain may have to discharge individuals from community-based services, potentially returning them to institutional settings and undoing decades of progress towards independence and inclusion.

Pediatric Rehabilitation

Medicaid is a key funding source for healthcare and rehabilitation services for infants, children, and adolescents living with disabilities and medical complexity. Even for families with a private primary insurance, Medicaid as a secondary insurance fills in the gaps in covered care. Children with disabilities, regardless of household income, are Medicaid eligible to offset the high costs of care. Medicaid cuts will negatively impact the most vulnerable in our state: children with disabilities and special health needs.

Early Intervention

Medicaid is a supplemental funding source for Early Intervention services in Pennsylvania. All Pennsylvanian families currently enjoy access to these crucial home- and community-based services with no cost-share. Cuts in funding to this program may cause tighter eligibility requirements or cost-shares for families, ultimately decreasing access to essential services.

How the Cuts Might Be Done

Work Requirements

At this point, work requirements appear to be one of the most likely paths to Medicaid cuts.

According to the Pennsylvania Health Access Network (PHAN), approximately 1 million adults in Pennsylvania would be subject to the work requirement.

Medicaid work requirements would require certain Medicaid enrollees to work, look for work, or conduct another qualifying activity (e.g., education, caretaking) as a condition of receiving health insurance. As part of such a requirement, all working age Medicaid enrollees may be required on a monthly basis to report their work or verify their eligibility for an exemption because they are in school or a job training program, caring for others, or disabled/in treatment. Failure to do so would result in them losing Medicaid coverage.

On the surface, increasing support for work requirements is understandable. Able-bodied citizens on Medicaid who can work, should work. What is not being discussed is the fact that most of these individuals are already working but at an income that still qualifies them for Medicaid. Further, studies from states that have attempted to implement a Medicaid work requirement show that the cost to the state to implement and administer such a requirement is in the tens of millions of dollars.

If work requirements become a reality, advocates must lobby for waivers for special populations.

Federal Medical Assistance Percentage (FMAP)

At this point, according to Speaker of the U.S. House Mike Johnson, FMAP (as well as per-capita caps, see below) are not a consideration for reducing Medicaid spending.

Each state’s FMAP determines its federal share of Medicaid funding. FMAP is a formula that uses the state’s most recent three-year average per capita income data to provide higher matching rates to states with lower per capita incomes relative to the national average. FMAPs have a statutory minimum of 50 percent and a maximum of 83 percent.

In Pennsylvania, 56 percent of Medicaid costs are paid with federal dollars, leaving Pennsylvania to cover the balance.

Under the Affordable Care Act’s Medicaid Expansion, the FMAP for what became the newly eligible population — mostly low wage workers who do not have coverage through an employer, disabled workers, caregivers to children or elderly family members, and students — is fixed at 90 percent federal funding, with the commonwealth paying for the balance.

Per Capita Caps

A per capita cap funding arrangement sets an upper limit on federal payments per Medicaid enrollee in each eligibility group. In an aggregated cap (also called a capped allotment) approach, states receive federal matching funds up to a determined maximum. If the cap is exceeded, the state bears 100 percent of that cost with no federal match.

Resources

There are many resources continually being developed and distributed. These include ways to take immediate action with Congress. The following are some of the most relevant to our membership.

Next Steps

RCPA will continue to closely monitor the issue. As Congress’s next steps become clearer, we will work with our partners, including you, to develop and execute strategies to stop Medicaid cuts or minimize the negative effects.

Contact your respective RCPA Policy Director with questions.

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The Department of Drug and Alcohol Programs (DDAP) today announced an investment of more than $2 million in grant funding for five Pennsylvania organizations to help improve Pennsylvanians’ access to substance use disorder (SUD) recovery houses that are licensed through DDAP.

Funding for these grants is provided from the more than $1 billion in funding Pennsylvania continues to receive from a large national opioid settlement with three distributors and one manufacturer.

DDAP is awarding five grants of up to $500,000 each to the following community-based organizations:

  • The Bridge Foundation: Philadelphia
  • The Worx!: Allegheny County
  • Sage’s Army: Allegheny, Westmorland, Fayette, and Washington counties
  • Westmoreland Community Action: Westmoreland, Fayette, Washington, Somerset, Bedford, Blair, Cambria, Greene, Lawrence, Butler, Armstrong, Indiana, Clearfield, Jefferson, Clarion, Mercer, Venango, Forest, Elk, McKean, and Crawford counties
  • Life Changing Pathways: Adams and York counties

The organizations are charged with leading initiatives to link individuals with opioid use disorder and any co-occurring SUD or mental health condition to DDAP-licensed recovery houses. They must also ensure these individuals have access to case management and peer support services while residing in a recovery house as well as access to financial assistance for those who are not able to pay the full cost of residing in a recovery house. In addition, all five grantees must have a plan to increase services to underserved populations and have a training plan to ensure staff are well-prepared to serve them.

Currently, there are about 400 DDAP-licensed recovery houses across the commonwealth. The purpose of the licensure program is to help empower sustained recovery for individuals with SUD by ensuring a network of safe drug and alcohol recovery houses. Individuals can find a listing of licensed recovery houses on DDAP’s website.

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Image by Werner Moser from Pixabay

Spotlight PA is covering Pennsylvania’s drug addiction crisis, its impact on children and families, and the potential to use opioid settlement funds to address associated problems. To help inform its coverage, the publication is seeking stories about how the opioid epidemic and addiction has affected Pennsylvanians, including frontline perspectives from healthcare workers, child welfare workers, counselors, first responders, and others addressing these issues regularly.

More information, including a form for submitting responses, can be found on Spotlight PA’s website.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) will host a webinar at 10:00 am on Monday, March 3, to discuss the changes to 42 CFR Part 8 and their real-world implications in treatment settings. The interactive session will feature Dr. Sarah Kawasaki and Elizabeth Ward, both from the Pennsylvania Psychiatric Institute’s Advancement in Recovery Opioid Treatment Program.

Add the meeting to your calendar.

Email DDAP to receive calendar invitations to upcoming webinars, which are held the first Monday of every month.

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