Medicaid Cutbacks in Maine Leave 400 OTP Patients without Coverage

medicaid“In what appears to be insult added to injury, Maine opioid treatment program (OTP) patients not only face having to prove themselves in order to stay in treatment for more than medicaidtwo years, but, due to a cutback in Medicaid, 400 of them will be left with no access to state-paid treatment no matter how well they are doing.”

Alcoholism Drug Abuse Weekly asked John A. Martins, spokesman for the Maine Department of Health and Human Services, in an e-mail what the state’s plans are for those patients.

“Substance use and abuse is not new in Maine or across the nation and occurred long before Maine’s initial expansion of the MaineCare program in 2002 to cover those who are losing coverage,” said Martins. “We remain committed to effective and efficient use of non-MaineCare resources to improve education and successfully prevent addiction and intervene early before addiction occurs.

http://www.alcoholismdrugabuseweekly.com/m-article-detail/medicaid-cutbacks-in-maine-leave-400-otp-patients-without-coverage.aspx

Source: AlcoholismDrugAbuseWeekly.com – January 27, 2014

Blog: What Health Care Reform Could Mean for Drug Policy and Mass Incarceration

healthcare reform 2“What does the Affordable Care Act (ACA) mean for drug policy?. A new issue brief – From Handcuffs to Healthcare — published by the Drug Policy Alliance (DPA) and the American Civil Liberties Union(ACLU) outlines how the ACA could help our country end the war on drugs and move toward a health-based approach to drug policy

This paper is intended as a starting framework for criminal justice and drug policy advocates to navigate the ACA, and to take advantage of the conceptual and practical opportunities it offers shifting the conversation and the landscape.

Part One of this paper describes some of the major provisions of the ACA relevant to our work: the health insurance requirement; the places many people will buy insurance, called health exchanges; Medicaid expansion; insurance coverage requirements for substance use and mental health disorders; and opportunities for improved models of coordinated care.

Part Two of this paper outlines a series of practical recommendations, including program and policy examples and suggested action steps, across three broad categories:

  • Ensuring access to care for people most likely to be steered into the criminal justice system under the current framework
  • Leveraging the ACA to reduce incarceration and criminal justice involvement
  •  Moving from a criminalization-based drug policy approach to one rooted in health

The Brief can be accessed at: http://www.drugpolicy.org/sites/default/files/Healthcare_Not_Handcuffs_12.17.pdf

Source: HuffingtonPost.com - December 3, 2013 and DrugPolicy.org – December 2013

In California, a Focus on Getting OTP Patients Enrolled in Medicaid

MediCalOpioid treatment programs (OTPs) have many patients—childless adults, mainly men—who have not been eligible for Medicaid. They are self-paying for their treatment. In these weeks before the Affordable Care Act (ACA) takes effect and self-paying patients can be covered under its Medicaid expansion provision, some OTPs are working feverishly to make sure that these patients are enrolled, and finally freed from the burden of paying out of pocket—something that will improve the chances that they will stay in treatment.

At Bay Area Addiction Research and Treatment (BAART), the focus is on implementing Medicaid expansion, said president Jason Kletter, PhD. BAART is based in California and has expanded into Arizona, North Carolina, Nebraska, and Vermont, serving more than 6,500 patients a day. BAART also provides primary medical care and mental health services through fixed sites and mobile vans.

“My organization has been certified as an enrollment entity, and we have about 30 people at sites around the state ready to enroll patients,” Dr. Kletter said. There have been logistical problems, but “we’ll get there eventually.” As in the rest of the country, technical hiccups in getting started are expected to be worked out well in advance of the January 1 ACA implementation date. “We currently have certified enrollment counselors who can’t do their job yet,” he said. The state’s exchange, Covered California, is managing the enrollment.

Dr. Kletter thinks the main advantage of Medicaid expansion will be to make sure current patients who are paying their own way will have insurance. “It’s a great benefit for these patients, because these are the folks who have a hard time staying in treatment.”

California Medicaid, called Medi-Cal, is still fee-for-service for treatment of substance use disorders (SUDs); many states are applying for federal waivers to put this population and health care providers under managed care. Instead, California went through a “realignment,” in which SUD treatment went from a centralized state management system to payment by the counties. “And they’ve added a lot of benefits to the Medicaid benefit, said Dr. Kletter—residential, intensive outpatient, and other services.

Medicaid money goes through the counties, and OTPs contract with each county, said Dr. Kletter. “After the realignment, I don’t see this being managed” by private insurance companies, he added.

But what about patients who already have commercial insurance—they have traditionally found it impossible to use their insurance to get reimbursed for treatment in an OTP, and they also had to pay out of pocket. That may be changing soon. “There’s been a recent change of heart, and managed care organizations are starting to reach out to OTPs in California,” said Dr. Kletter. The OTPs met with the state last year about this. “We think that the exclusion is discriminatory,” he said, referring to insurance policies that specifically excluded treatment with methadone in an OTP, or any treatment in an OTP. Of course it is discriminatory, under the ACA and the parity law. Any change in this would be a “great development,” Dr. Kletter believes, expanding OTP access not only to many people covered by Medicaid but also to people covered by private insurance.

Site last updated March 28, 2014 @ 7:50 am