Will Medicaid pay for CBD oil?
Joshua McCarthy, a 45-year-old Boston resident with multiple sclerosis, admits that he sometimes struggles to afford his therapeutic cannabis and CBD. A 2017 web-based survey, hosted by the National Multiple Sclerosis Society, found that 66% of individuals with multiple sclerosis use cannabis for symptom treatment. Cannabis can help patients reduce fatigue, pain, spasticity, and ultimately improve mobility.
To get his medical cannabis, Mr. McCarthy estimates that he pays more than $4,200 per year to relieve his pain. A former employee of a body shop company, Mr. McCarthy says he currently lives on a premium paid for by his disability insurance. While his wife also has a job, they are raising two teenagers. In this context, unfortunately, paying more than $4,200 annually is a huge burden on their family budget. Currently, Mr. McCarthy receives no insurance coverage for the CBD and medical marijuana that he needs to manage his symptoms.
What is CBD oil?
CBD is a cannabinoid found in the Cannabis Sativa plant species. Cannabis Sativa is the species of plant that is commonly known as pot, weed or marijuana. This cannabis plant contains many different chemicals called cannabinoids. Two of the most famous cannabinoids found in cannabis are THC and CBD. However, researchers have found more than 100 cannabinoids as well as other smaller organic compounds, known as terpenes, in the plant. “Hemp” is a category name for the different strains of Cannabis Sativa that are rich in CBD and contains less than 0.3% THC. While, in the common vernacular, hemp and CBD are generally used as interchangeable terms, the hemp plant is a strain of the Cannabis Sativa plant which contains a high volume of the cannabinoid known commonly as CBD. CBD does not cause any of the side effects associated with THC, including a “high” feeling, dizziness, headache, dry mouth, etc. Using CBD can help manage symptoms of and conditions like epilepsy, seizure disorders, pain and inflammation, PTSD, anxiety, Crohn’s disease, multiple sclerosis, opioid withdrawal and many more.
Is CBD legal?
Purchasing CBD is federally legal as long as it doesn’t contain more than 0.3% THC. In 2018, the Farm Bill changed hemp plants fitting the above description from a controlled substance to an agricultural commodity, meaning that farmers across 50 states could grow hemp legally. This moved CBD from the purview of the Drug Enforcement Agency to the purview of the Food and Drug Administration. The use of hemp oil or CBD oil is considered federally legal in all 50 states.
The FDA has prohibited the sale of CBD in any unapproved health products, dietary supplements or food. This means that a store can sell as much CBD as it wants, as long it doesn’t make any direct health claims about its product. To avoid these regulations, oftentimes on CBD websites you will see phrases like “CBD has been shown to” or “CBD may help in” rather than “CBD will cure this disease.”
The one exception to this rule is the drug Epidiolex – the only FDA-approved prescription CBD used to treat seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome or tuberous sclerosis complex (TSC). Any other CBD product (from CBD edibles to CBD oil) is legal as long as it doesn’t purport any health claims.
What is medical marijuana?
Medical marijuana is when the Cannabis sativa plant is used for medicinal purposes. This is the whole Cannabis sativa plant which contains CBD and THC as well as other cannabinoids and terpenes. Medical marijuana does produce a “high” feeling but that is a secondary benefit. Medical marijuana is used to treat a variety of conditions including, but not limited to, Alzheimer’s, appetite loss, cancer, Crohn’s disease, HIV/AIDS, epilepsy, glaucoma, mental health conditions, multiple sclerosis, muscle spasms, pain management, nausea, pain and seizures. Medical marijuana will cause the side effects commonly associated with THC.
Is medical marijuana legal?
Marijuana is still considered illegal at the federal level. It is classified as a Schedule I controlled substance under the Federal Controlled Substances Act. Schedule I drugs are “substances with no currently accepted medical use and a high potential for abuse” as defined by the United States Drug Enforcement Agency. This does not mean that medical marijuana has no medical use, only that the federal government has not accepted the potential medical benefits of marijuana.
However, state laws have made at least some forms of medical marijuana available in every state outside of Idaho, Wyoming, Nebraska, Kansas, Tennessee, Alabama, and South Carolina. Due to the complicated legality, technically a doctor cannot write a prescription for medical cannabis. However, they are able to write a recommendation or authorization for medical marijuana which you can then take to a medical marijuana dispensary to get filled.
How does cannabis work in your body?
Cannabinoids in the Cannabis sativa plant, like CBD and THC, act on CB1 and CB2 receptors in the endocannabinoid system in the human body – which regulate sleep and sleep problems, mood, appetite, memory, immune responses, reproduction and fertility. The endocannabinoid system is a network of receptors in our bodies that researchers still do not fully understand. These receptors create natural endocannabinoid substances to keep our bodies in homeostasis. This system is fully functional in all humans, even people who have never tried cannabinoids before. The system is only named after the cannabis plant that led to its discovery. The effect of Cannabis sativa and its’ various cannabinoids on your body’s endocannabinoid system vary based on dosage, frequency of usage, weight, as well as a variety of other factors.
Will Medicaid or Medicare cover medical marijuana or CBD?
Medicare and Medicaid are two separate, government-run and federally funded insurance programs for different, underserved groups of individuals. Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income. If a person qualifies for both, they can use both insurances.
Medical marijuana is federally illegal and, while buying and growing CBD is federally legal, CBD in any FDA unapproved health products (all of them) is not. Unfortunately, this means that a federally funded insurance program, like Medicaid or Medicare, will not cover CBD or medical marijuana. Neither Medicare.gov or Medicaid.gov references CBD or potential coverage on their websites. This medical marijuana ban also extends to Medicare Advantage (a type of health insurance plan in the United States that provides Medicare benefits through a private-sector health insurer).
While the health benefits of CBD oil and medical marijuana have been studied, the federal government needs more peer-reviewed and widespread clinical data to approve this product for individuals’ uses. However, this is a lengthy process and further complicated by the fact that Schedule I drugs are banned from receiving federal or state research grants to study their efficacy as medical treatments. Even if marijuana is federally legalized, the process for approval of prescription drugs through the FDA takes years and extensive studies. And federal insurance programs like Medicaid or Medicare only provide medical coverage for verified, researched, and governmentally approved medical treatments.
Will other insurance policies cover CBD or medical marijuana?
Unfortunately, the answer is no again. According to federal law, Americans who use marijuana to treat health issues can’t legally possess, sell, give away, or grow it. Doctors, physicians, and other healthcare providers can’t prescribe marijuana to patients, although they can “recommend” or “authorize” it thanks to the First Amendment. This odd “technically illegal” status causes complications.
Insurance companies in the United States won’t pay for anything that’s technically illegal. Most health insurance policies include what is known as an “illegal acts exclusion.” This exclusion policy varies from state to state and insurance provider to insurance provider. However, the gist is that health issues that occur due to or in association with your voluntary involvement in an illegal act are not covered. Even though medical marijuana is legal at the state level and CBD (for use outside of health benefits) is legal at a federal level, marijuana is still classified by the federal government as a schedule I controlled substance. Therefore insurance companies can wash their hands of providing coverage by citing this illegal acts exclusion.
Additionally, each health insurance plan has a drug formulary – a list of medications it covers for health plan members. Marijuana would need to be added to your insurance’s prescription drug formulary before it would be a covered benefit of your health insurance and it would be highly unusual for a health plan to add a drug to its formulary if the drug hasn’t been FDA approved. This process is lengthy and time consuming so many people are left waiting, while draining their savings, to pay out of pocket for the medical cannabis they need.
How much does CBD cost?
The price of CBD is incredibly variable due to the widespread availability and lack of regulation. If you head to a local gas station, you can probably find some CBD oil at the checkout counter. However, this CBD is dangerous.
When the 2018 Farm Bill moved CBD from under the purview of the Drug Enforcement Agency to under the purview of the Food and Drug Administration, there was no update in safety regulations. The FDA is responsible for protecting public health by regulating human drugs and biologics, animal drugs, medical devices, tobacco products, food and cosmetics. However, even though CBD can be used in all of these forms, it’s purity and quality is not regulated by the FDA. The FDA has said that “CBD products currently sold in the United States are unregulated and untested” and that some of their own testing has revealed that some CBD products contain toxic metals, pesticides and THC. So while that gas station CBD might be cheap, it also might not be safe.
More than just unsafe, these CBD products will not be as effective or provide nearly as many health benefits because of the poor quality. While it is more expensive, getting your CBD from a pure and trusted source is incredibly important to ensure your safety and the products’ efficacy.
How much does medical marijuana cost?
The costs vary greatly and depend on your location as well as your condition. There are a number of increasingly costly steps to legally obtaining a medical marijuana card. As medical marijuana is regulated on a state level, the exact process varies from state to state but the general formula is below.
To receive access to medical marijuana, you must be diagnosed with a specific medical condition that is approved for medical marijuana use in your state. This list of medical conditions can be quite lengthy (as in Colorado and Oregon) or very short (as in Texas). This diagnosis must be made by a licensed medical marijuana physician. After finding a provider in your area, call ahead to see if your initial consultation visit is complimentary or out of pocket. You will need your ID and proof of residency for this visit.
After the doctor determines a diagnosis, they can write a recommendation or authorization for medical marijuana. The patient then submits all required forms online which include the application, proof of residency, the doctor’s recommendation, any caregiver form, and an application fee.
The state department that oversees the medical marijuana program evaluates the patient’s online application and, if approved, mails them a medical marijuana card. This process can take up to a month. These cards are valid for a year after they are issued. After that, the patient must meet with their doctor and fill out the application form once again.
Patients are solely responsible for paying the application fee which can range from $50 to $300 to even more, depending on the state.
The array of marijuana products available and the prices will range based on the dispensary you choose. Once the medical marijuana card is obtained, the patient can choose any product or combination of products as long as the amount doesn’t exceed the 70-day allotment of medication you are allowed at once (this allotment varies by state).
According to CostHelper, the following price approximations are…
- A gram of buds can cost $5-$20
- An eighth of buds (3.5 grams) costs $20-$60
- An ounce of buds can cost $200-$400.
- More concentrated products (hash products, oils, and waxes made with higher levels of THC) generally cost $20-$60 per gram and can be purchased by the half gram or gram.
- Edible medical marijuana products will run you anywhere from $2-$5 per dose.
- Concentrated liquid medical marijuana (referred to as tinctures) are usually sold in 1-ounce bottles for $15-$50 each.
How can I afford CBD or medical marijuana on my own?
Using CBD products or medical marijuana long term can quickly add up and insurance will not cover CBD or medical marijuana. Unfortunately, there is little help available to allow financial access to these marijuana medications.
If you get a medical marijuana recommendation or authorization for a doctor, you should expect to have to pay full price from legally licensed dispensaries. However, there are a number of state programs that can provide financial assistance. For example, in Berkeley, California, a city ordinance helps residents making less than $32,000 per year (or $46,000 for a family)of four) can access their medical cannabis for free from local medical dispensaries. In Oregon, the Oregon Health Authority oversees the Oregon Medical Marijuana Program and offers reduced-price application fees for state medical cannabis cards. And, in Florida, the Rainy Day Foundation nonprofit provides financial assistance for low-income, disabled individuals to cover the cost of doctor’s referrals and the Florida medical cannabis card.
Patients who live in a state without a financial assistance program are left to the mercy of dispensaries to afford their medicine. Some dispensaries offer a kind of discount program or coupons for those in financial hardship with a medical marijuana card. Additionally, some dispensaries offer discounts based on age, military service, or other criteria. Check out the websites of dispensaries in your area and don’t be afraid to call ahead and ask.
To pay for CBD, patients have a few more options. Since it is easier to obtain, individuals can search out the best deal from both brick-and-mortar stores and online. However, it is important to choose CBD with purity, clarity, and safety in mind as well as price.
CBD Oil as a Covered Medical Expense Under the Longshore Act and DBA
CBD oil can be a covered workers’ compensation expense under the Longshore and Defense Base Acts. As of now, medical marijuana is not.
Section 7 of the Longshore and Harbor Workers’ Compensation Act requires employers to pay for reasonable and necessary medical treatment associated with an employee’s work-related injury. See 33 U.S.C. 907. That same law also applies to the Defense Base Act. See 42 U.S.C. 1651.
Recently, Judge Carrie Bland juxtaposed the completely legal use of CBD oil with the lack of coverage typically afforded by federal administrative courts to medical marijuana. The following passage is from Rykaczewski v. Ceres Marine Terminals, OALJ No. 2018-LHC-00075 (OALJ Dec. 12, 2020) (internal record citations omitted):
Ceres next posits that it cannot be held responsible for providing Rykaczewski with Cannabidiol (“CBD”) or marijuana. Rykaczewski testified that he uses CBD to help with his anxiety. Further, Ceres indicates that Rykaczewski submitted as an exhibit a prescription fromAnderson for “120.00 grams of certified dry cannabis flower,” which it likewise cannot be held responsible for providing.
Rykaczewski’s use of CBD is legal under state and federal law. Under the 2018 Farm Bill, CBD derived from hemp products was removed from the Controlled Substances Act and was legalized underfederal law. See Agriculture Improvement Act of 2018, Pub. L. 115-334, § 12619. Further, hemp-derivedCBD is legal in Maryland, where Rykaczewski resides. See 2016 Md. HB 443. Accordingly, Ceres must pay for hemp-derived CBD.
Marijuana is illegal under federal law. Despite recent attempts to reschedule it, marijuana remainsclassified as a Schedule I controlled substance under the Controlled Substances Act based on its highpotential for abuse, no accepted medical use, and no accepted safety for use in medically supervised treatment. 21 U.S.C. § 812(b)(1). Conversely, under Maryland law, a qualifying patient may use and be in possession of cannabis-derived products for medical purposes if legitimately prescribed by a certifyingprovider. Md. Code Ann., Health–Gen. § 13-3313 (2013).
The question before me is not whether marijuana has therapeutic value. Instead, the issue here is deceptively simple – the interplay between the CSA’s current placement of marijuana in Schedule I and Section 7 of the LHWCA. While medical professionals may disagree, so long as it remains classified as a Schedule I controlled substance, marijuana has no accepted medical use under federal law and no accepted safety for use in medically supervised treatment. A drug that has no accepted medical use under federal law can never constitute reasonable and necessary medical treatment under the LHWCA. In other words, if adrug has no accepted medical use under federal law, then a federal ALJ has no authority to compel an Employer or Carrier to pay costs associated with the use of that drug as part of a course of medical care and treatment under the LHWCA, even in those states that have authorized the doctor-recommended use of marijuana. Accordingly, Claimant’s request for a finding that medical cannabis treatment is covered under 33 U.S.C. § 907 is denied.
The ruling on medical marijuana is not surprising. Although some of my colleagues undoubtedly disagree–and I hope I am proven wrong–I do not anticipate federal administrative law judges will order employers to pay for medical marijuana under a federal workers’ compensation scheme until Congress changes the classification schedule for marijuana. One day, there will be a change; but not yet.
CBD is another story. If a doctor says that CBD oil is reasonable and necessary, then employers should pay for the medical treatment. That is a benefit for claimants because CBD treatment can be expensive.