Forecasting Neonatal Abstinence Syndrome Cases

In 2013 and 2014, more Virginians died from drug overdoses than car accidents or homicides, according to Virginia Department of Health data. The data also show that nearly 80 percent of drug overdose deaths were attributed to prescription opioids and heroin. Many Virginians who suffer in this epidemic are adults. But there is another group afflicted by this scourge – babies born to mothers with substance use disorders (SUD). Babies born addicted and diagnosed with Neonatal Abstinence Syndrome (NAS) typically have expensive neonatal intensive care (NICU) stays, short-term suffering, and long-term behavior problems. Each day in the NICU adds an additional $1,246 to the cost of care, according to information from Virginia’s All Payer Claims Database (APCD). In addition to NICU stays, addicted infants generally need three months of ambulatory care for drug withdrawal. Regrettably, there have not been many options for pregnant women with SUD to receive treatment and prevent birthing an NAS child. While most hospital births in Virginia are covered by Medicaid, the state Department of Medical Assistance Services’ (DMAS) low payment rates for SUD treatment do not cover a provider’s cost so fewer providers offer SUD services to Medicaid recipients. This is unfortunate as pregnancy tends to be the time when addicted women are most motivated to stop using drugs. Consulting the APCD, VHHA used linear regression to predict the numbers of NAS newborns under current payment policy. Based on currently reported claims, it is projected that the number of NAS admissions reported in 2012 could quadruple by 2018 (see chart below).


NAS is preventable if pregnant women obtain treatment for opioid addiction. Neglect due to substance abuse disorders was the second-most commonly cited reason Virginia children entered foster care in 2013. Data show more than half of mothers with children in foster care waited more than 12 months for court-mandated SUD services. Meanwhile, Medicaid rates for SUD treatment have not increased since 2007 and continue to fall short of the actual cost of providing care. DMAS has proposed increasing treatment for SUD by 50-400 percent depending on the treatment modality. VHHA and the Virginia Department of Health will continue to track the effect of the new payment policy. (4/1)