Pennsylvania's Medicaid System Leaves Addicts Without Coverage

By Paul Gaita 01/29/15

Thousands of addicts are left without coverage thanks to a technical glitch.

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A technical glitch in the expansion of Pennsylvania’s Medicaid system has left thousands of individuals with substance abuse and mental health issues without proper insurance and facing serious, and even life-threatening problems.

Drug, alcohol, and mental health providers were assured in early 2014 that the transition from traditional Medicaid to Healthy PA, a subsidized, Pennsylvania-based program that offers coverage through private health carriers, would not affect their clients.

But with the December 1 rollout of Healthy PA, many of the 162,000 Pennsylvania residents in treatment for addiction or mental health issues discovered that they had actually been sorted into plans that did not offer coverage for those conditions, leaving providers without the means of being reimbursed by the state. As a result, many of those residents are facing disruption or even the possibility of being locked out of their treatment programs.

“It’s just incredible,” said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania. “We have families who desperately want help, kids who want help and access. This has become a nightmare.”

In a letter issued in mid-January, the Department of Health and Human Services assured behavioral health providers that they were aware of the problem and were working with substance and mental health groups to prevent interrupted service for patients. No substantive solution has been reached, which has forced many providers to direct their clients to county assistance offices, where uninsured residents can receive treatment.

However, lack of adequate funding and lengthy waiting lists in those offices may put new clients in a no-win situation that could have serious consequences for their health, from impaired driving to drug overdoses. Pennsylvania is already seventh in the nation for the largest number of drug overdose deaths.

State Representative Gene DiGirolamo (R-Bucks County), whose son is a former heroin addict, points to outgoing governor Tom Corbett as the source of the problem. Twenty-six states expanded their Medicaid program along the lines proposed in the 2010 Affordable Care Act, but Corbett’s version consolidated Medicaid health plans and required low-income individuals to pay premiums. According to DiGirolamo, the decision made the expansion even more difficult, and resulted in the current situation.

“As far as I’m concerned, this is a life-or-death issue,” he said. Michael Harle, president and CEO of Gaudenzia, the state’s largest drug and alcohol treatment center, says that a solution is within reach. “It’s called HealthChoices and has been in place since the ‘90s,” he said, referring to the state’s mandatory managed care program for Medical Assistance recipients. “It has rules and a system and a common language that people understand."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.