July 17, 2018
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Acadia cuts free methadone to uninsured clients

By Meg Haskell, BDN Staff

BANGOR, Maine — The Acadia Hospital no longer will provide free methadone treatment to uninsured, opiate-addicted patients, with hospital officials saying the high cost of the program is placing too great a financial burden on the Bangor psychiatric facility. As a result of a recent restructuring, the outpatient methadone program was moved out of hospital services and under the organizational umbrella of Acadia Healthcare Corp. That change relieves the obligation to provide free care to opiate-addicted patients who have no health care coverage, Brent Scobie, Acadia’s vice president and chief of clinical services, said Thursday.

The change was adopted to ensure the methadone program’s financial future, he said.

“We believe methadone is an important service to offer at Acadia,” Scobie said. “We’ve been committed to it since 2001 [when the methadone clinic opened].” But the state mandate to provide free care to low-income patients without health care coverage was placing too great a burden on the hospital, Scobie said.

All acute-care hospitals in Maine are nonprofit and required to provide a level of free care to people without insurance coverage who cannot pay out of their own pockets. MaineCare, the state’s Medicaid program for low-income and disabled individuals, pays for the majority of all care provided at The Acadia Hospital.

But many methadone clients do not qualify for MaineCare coverage. Of a total of $4.5 million in unpaid services delivered last year by The Acadia Hospital across all its inpatient and outpatient programs, “a significant majority” was provided through the methadone clinic, Scobie said. The hospital realizes about a 2 percent profit each year, which is returned to the organization in the form of services, equipment and facilities, he said.

The Acadia Healthcare Corp., while still a nonprofit organization, is considered a community-based organization and is not required to treat the uninsured. While the $72 per week it receives for each MaineCare methadone client is slightly less than was paid under the hospital umbrella, that reduction is more than offset by dispensing with the free care requirement, Scobie said.

Of the approximately 550 clients enrolled in the methadone program at the beginning of August when the change took effect, about 100 were receiving free care, he said. About 70 of these clients have opted to find the $72 a week it costs to continue participating in the program, he said.

Clinicians have been working with the others for several weeks now, preparing them to discontinue daily methadone dosing and encouraging them to participate in an abstinence-based recovery program, Scobie said. As of Thursday, about 30 clients still were tapering their methadone doses.

Many of the displaced methadone clients will transition into The Acadia Hospital’s abstinence-based outpatient addiction program, called “Moving On,” Scobie said. The program draws heavily on the 12-step model developed by Alcoholics Anonymous, and emphasizes peer support and professional counseling.

Scobie said that earlier assumptions about methadone are being challenged, including the idea that it is in most cases a lifelong therapy.

“For many of these people, when they are provided with the right level of therapeutic support … to say there are no other options [than methadone] really minimizes the potential for recovery,” he said.

Guy Cousins, director of the Maine Office of Substance Abuse, said earlier this week that the changes at The Acadia Hospital come in response to recent budget cuts in the MaineCare program. Before the organizational change, Acadia’s program was the only hospital-based methadone clinic in the state, he said.

There are about 4,400 opiate-addicted Mainers enrolled in methadone treatment, Cousins said, receiving daily doses of the synthetic narcotic and other support services from eight private nonprofit methadone treatment clinics in Maine. The clinics are located in Bangor, Westbrook, Calais, South Portland, Portland and Waterville. A ninth methadone clinic located in Rockland closed last week after a federal investigation into illegal drug activities by the clinic’s owner and a counselor there. None of these clinics is required to provide free methadone treatment.

The 100-bed Acadia Hospital provides acute inpatient psychiatric care as well as outpatient mental health and substance abuse services. The outpatient methadone program is licensed to treat up to 900 clients. Scobie said the program at Acadia has not been full since 2006 or 2007, and he said the wave of prescription drug addiction that engulfed rural Maine a few years ago may be receding.

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