Program growth aids more drug treatment

Md. shifts funds to get U.S. help, expects reduction in backlog

February 09, 2010|By Scott Calvert | scott.calvert@baltsun.com

It's been a busy year so far at Powell Recovery Center in Upper Fells Point. About 40 new clients have walked into the drug treatment center since the state expanded substance-abuse coverage for low-income Maryland residents Jan. 1.

State officials hope that getting more addicts into treatment will ease a major backlog, especially in Baltimore. While some centers worry that the expansion will prove burdensome, Powell Recovery's president sees only an upside: He predicts his center will be able to serve more than 2,000 drug users this year, up from 1,500 last year.

"This is opening up another avenue for treatment for people who heretofore could not have gotten service, or may have had an extended period of waiting," said Bill Scott, the center's president.

Cash-strapped Maryland is paying for the expansion without spending an extra dime of state funds. Officials have shifted funds already allocated to a grant pool into a program that uses a dollar-for-dollar federal match to double the state's money.

"In these economic times, it's really hard to come up with new money," said Kathleen Rebbert-Franklin, deputy director of the state Alcohol and Drug Abuse Administration. "This is a way for us to create an additional amount of money that would expand the amount of service available to substance users."

She said it's too early to say how many more people will receive treatment. "It will help to close the gap," she said, "but the gap is still significant, and it's a challenge."

The challenge is acute in Baltimore. Some 70,000 city residents need treatment, according to the Baltimore Substance Abuse Systems Inc. Less than a third of that number - 22,713 - got treatment in 2008.

The expansion "has an immediate effect," said Dr. Yngvild Olsen, medical director at BSAS. "The anticipation and hope is we really will be able to increase access to effective treatment."

The change lets individuals who make less than $12,552 a year get treatment through the state's Primary Adult Care program, which provides limited benefits to those ineligible for Medicaid either because they are not disabled or they do not have dependent children.

Previously, such individuals could get drug treatment only through the state's grant program. But advocates say the grant-funded slots were capped at a level that did not come close to meeting the need for services.

The grant program will still fund much of the treatment for non-Medicaid recipients, at least for now. For the first half of this year, the state has shifted $3.3 million into the adult-care program from the grant, which stood last summer at $150 million. In the fiscal year starting in July, the state plans to shift $6.7 million to the program.

Under Gov. Martin O'Malley's budget proposal, 61,000 people statewide would receive grant-funded treatment next fiscal year, while 45,000 would be eligible for the adult-care program's services through one of five participating managed-care companies.

The expansion push was led by Del. Peter Hammen. The Baltimore Democrat wanted to extend the reach of the adult-care program, formed in 2006 under a waiver with the federal government. Before the expansion, the program covered primary care, pharmacy benefits and mental health care but not drug treatment.

"We should never leave one red cent of federal dollars on the table," Hammen said. "We should be leveraging state matching dollars as much as we can. Then we can expand access to these vital services."

The program's substance abuse coverage pays for assessments, individual and group therapy, intensive outpatient services and methadone maintenance. It does not include detoxification.

Some providers are uneasy about the change. They worry that the complexity of billing managed-care groups will prove onerous for smaller operations that have relied on state grants. There are also concerns about long lags between the submission of claims and payment.

"Programs like mine, if we don't get money, we are not going to be able to pay our counselors," said Benita Paschall, director of Echo House in West Baltimore. "If we can't pay our counselors, we're not going to be able to operate."

Paschall said she fears managed-care organizations will press for counselors to end treatment too soon by saying continued therapy is not "medically necessary." Meanwhile, the state's budget crisis has prompted officials to trim $6 million from the grant in recent months, not counting the $3.4 million shift. With less grant money available, Echo House had to lay off three of its 17 employees, including intake specialists, Paschall said.

Even at the much larger Total Health Care, with years of Medicaid billing know-how, managers are wary of the change. "What we hope is it will increase capacity for the program," said Wendy Merrick, the organization's director of the substance abuse program.

State and local governments have provided technical assistance to help treatment centers adjust, and the state raised reimbursement rates.

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