Turning the Tide: Q&A with West Virginia Medicaid Director Cindy Beane on Substance Use Treatment Progress

You have been serving as West Virginia’s Medicaid Director for nearly eleven years. What motivated you to pursue a career in public service?

I’m very mission-driven when it comes to what makes me work hard and what makes me tick. Beyond making a living and providing for my kids, I want meaning in my work. Working at Medicaid allows me to touch the lives of so many people and make things better for my state. As a lifelong West Virginia resident, this state has been very good to me, and I want to be very good to West Virginia.

I’ve seen the benefits of the Medicaid program firsthand through lived experience. My grandmother was able to age in place because of a Medicaid waiver program. Before I even realized it was Medicaid, I saw how those services allowed my mom and aunt to continue working while providing care. My grandmother lived with my aunt until the end of her life in her nineties. I also had an uncle who received nursing home care through Medicaid, which allowed him to be in a facility close to my father, who could visit him every day at the end of his life.

West Virginia has seen remarkable success in reducing overdose deaths. What specific Medicaid initiatives have contributed to this dramatic improvement?

We were one of the first states to receive an 1115 Substance Use Disorder waiver. We went from West Virginia Medicaid paying for zero residential beds to having about 1,800 beds around the state today. We also added peer supports and medication-assisted treatment.

Current data shows a 41.7% decrease in overdose deaths from January to August 2024 compared to the same period in 2023, with the reduction expected to remain above 35% as pending cases are resolved. Year-over-year figures for the 12 months ending in August 2024 reveal a 32.79% decline in drug overdose deaths in West Virginia, surpassing the national average decrease of 23.7%. This reduction translates into 386 more people – 386 family members, friends, neighbors, co-workers – that are alive today, continuing their journey toward recovery and stability.

We have a pretty extensive continuum of care, and we work closely with our Office of Drug Control Policy and our Bureau for Behavioral Health to wrap around those other services. This ensures that a person seeking treatment and trying to maintain recovery has many different supports available to them.

How are you measuring success beyond the reduction in overdose deaths? What other metrics matter to you?

While overdose deaths are a key measurement given our high rates, that’s not the only metric that matters. We measure the effects of the program and the impacts of recovery, which include cost savings for the state compared to someone actively engaged in addiction. ER visits go down, and healthcare costs for those individuals decrease while they’re in recovery.

We also look at qualitative metrics. Through our 1115 waiver evaluation, we interviewed individuals who received services to understand what they believe is most important in keeping them in recovery. Interestingly, peer support services, which we started with that waiver, were identified by most respondents as what really helps keep them in recovery.

In our next iteration of the waiver, we’re focusing more on outcomes. Are people really involved in their community? Are they staying employed? We’re working with our managed care organizations and providers on how to track this information after people complete treatment. This is really what it’s all about – that they’ve got their lives back.

As the former President of the National Association of Medicaid Directors, how did that leadership experience inform your work in West Virginia?

I was so grateful to have that position. Coming from a small state, it was important to be able to see how Medicaid is run across the country. People say, “You’ve seen one Medicaid program, you’ve seen one Medicaid program,” and there’s a lot of truth to that. Some programs are county-based, some are state-based, with many different nuances.

But there are also many similarities. When I had the opportunity to talk with directors from small states, red states, blue states – we all faced some of the same challenges. Many of us were struggling with children in the child welfare system and the explosion of children’s and adolescents’ mental health issues after COVID. These issues happened at once for everybody, and we could share how each state was tackling them.

It gave me perspective that even though West Virginia is very different from Texas or California because they’re huge, we have many of the same issues, and similar solutions can work across the country. Without that opportunity, I wouldn’t have gained this understanding. It was truly the opportunity of my lifetime to see how Medicaid is impactful everywhere.

What advice would you give partners that want to work more closely with Medicaid?

Partners often don’t understand what Medicaid covers. Sometimes it’s really just a language barrier. Working with our child welfare system, they would ask, “Can you provide this wraparound service?” and we’d respond, “You mean case management?” Sometimes it’s just about terminology – we can do it, but we call it something different.

There can be a learning curve with how we refer to things and how we pay for services. Medicaid uses terms like 1915(c), 1115, and CPT codes, which can be confusing for partners used to grant-based funding. With grants, there’s often less accountability than with Medicaid’s claims and codes. But at the end of the day, it’s worth it because services that might only exist as small pilots through grants can become statewide services through Medicaid.

Get to know your Medicaid director. The Medicaid director is the person who can really help. Often we have common goals – like with the substance use disorder epidemic in West Virginia, it was all hands on deck. We couldn’t have achieved our outcomes if Medicaid worked in a silo. We had to include the Office of Drug Control Policy, our public health agencies, and our behavioral health agencies to address the full scope of the problem.

When we all come together to figure out what Medicaid can do and what others can do, we make a complete package. Medicaid directors aren’t in this job for the title – they want to make sure their programs work efficiently and do good in their states.

Thank you, Cindy, for telling us about West Virginia’s incredible achievements over the years, and for your leadership – both in your state and at NAMD!