By Peter Breslin, MD, FAPA
Board Certified Psychiatrist
Board Certified Addiction Medicine
On July 1, an important change quietly went into effect in Virginia that could save lives. Buried within the state budget, item 288 #12c ensures that hospitals can now be reimbursed for providing long-acting medications to patients with serious mental illness and substance use disorders.
That may sound technical, but the impact is anything but. For years, physicians across Virginia have faced a frustrating gap in care. While Medicaid reimbursed long-acting medications in outpatient settings, it did not allow the same for hospitals and emergency departments. This meant that some of our most vulnerable patients, those in crisis and often hospitalized after an overdose or psychiatric emergency, could not start long-acting medication before discharge.
These medications, whether used for opioid use disorder or schizophrenia, are critical tools. They improve treatment adherence, reduce relapses and readmission, and give patients stability during some of the hardest moments of their lives. By fixing this reimbursement gap, Virginia has made it possible for hospitals to initiate treatment immediately, not days or weeks later. That can make the difference between recovery and relapse, and sometimes between life and death.
The policy change was the result of broad collaboration. Governor Glenn Youngkin included the original language in his December 2024 budget to support patients with serious mental illness. Legislators from both parties, including Senator Creigh Deeds and Delegate Betsy Carr, worked to expand it to include substance use disorder. Advocacy groups, hospital leaders, and physicians across the state came together to support this reform. It is an example of how bipartisan cooperation can lead to meaningful, compassionate policy.
In my own work treating addiction and mental illness, I see every day how fragmented systems can fail patients. Progress like this shows that practical steps, often administrative rather than headline-grabbing, can have profound ripple effects across communities.
Virginia continues to face an opioid crisis that affects every region of the Commonwealth. Nearly eight Virginians die every day from an opioid overdose. Behind each statistic is a family, a child, a community member. While no single policy can solve the crisis, removing barriers to evidence-based treatment is a crucial foundation for saving lives.
As we look to the future, this kind of thoughtful, data-driven reform should guide our approach. The solutions that work in addiction and mental health are rarely partisan. They are grounded in compassion, science, and a belief that recovery is possible when access to care is not limited by bureaucracy.
Virginia took an important step this summer. Now we have to build on it, so that every patient in every hospital can receive the treatment they need to survive and to heal.
