Funding Change Hits Poor Maryland Addicts
The switch to Medicaid should help more people in the long run—but some who need treatment now are out of luck.
A major change to how Maryland pays for substance-abuse treatment has brought an increase in the number of addicts and alcoholics who get help—but allows many other needy people to slip through the cracks. Susan Tangires, LCPC, LCADC, the director of Epoch Counseling Center, which runs a network of non-profit drug and alcohol treatment centers in the state, tells The Fix that previously, “Substance-abuse treatment for uninsured individuals was covered through block grant funding—federal money that flows to and is distributed by each state.” But in 2009, the Maryland legislature decided to begin making annual transfers of funds from the state’s Alcohol and Drug Abuse Administration (ADAA) grant program to its Medicaid program, in order to qualify for federal matching funds and increase the sums available to pay for substance-abuse treatment for poorer people.
While that plan makes sense to Tangires—and, according to Maryland’s Dept. of Health and Mental Hygiene, has contributed to a jump from 1,946 participants in Medicaid’s Primary Adult Care (PAC) program in Maryland in 2009 to a projected 16,351 this year—it also has some problems. Tangires tells us that while the previous system of block-grant funding was “secure and counted-on,” dollar amounts using the Medicaid system are tied to how many people a treatment center serves, and how many services it provides. Not only that, but to get reimbursed, treatment centers must bill one of seven different managed-care organizations, adding complexity to the process.
“In the past, programs had the ability to take people in whether they had insurance coverage or not," Tangires says, "and now it’s going to be really important for people to apply for Medicaid.” That's simple in theory. But many who are eligible for the program don't follow through in the application process. More ominously, Tangires also points out that Medicare, the federal insurance program for the elderly, doesn't cover substance-abuse treatment. “We are definitely seeing an aging of our substance-abuse population,” she says. “They’ve been served by block-grant funding in the past, but not any longer.”
Epoch knew for several years that this change was coming, but had no idea how big a cash loss it would represent. Although Tangires initially expected a cut of 8–10%, she was told in May that Epoch’s funding would be slashed by nearly $300,000—20% of its grant money, or 10% of its overall operating budget. “There was no way we were going to be able to absorb that amount of cut quickly, so the only thing we really could do was to close the smallest of our four centers,” says Tangires. This is Epoch’s Lansdowne center, which has been treating 90 people at a time on an outpatient basis (Epoch doesn't provide residential treatment). Tangires explains that they're currently trying to whittle down the number of people at Lansdowne to 40 or 50 who will—in a month or two, when Lansdowne closes for good—be willing to transition to Epoch’s Catonsville center, which has a capacity of 175. So Epoch has stopped taking clients at Lansdowne, and has instead been adding names to a lengthening wait list. “But what we’ve found from having a wait list … is that when we finally lift it, maybe one out of 20 people actually show up,” Tangires says. “It wasn’t that they went somewhere else, it was just that they didn’t come back.”