June 22, 2018
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3 ways we can overcome challenges to expanding health care

BDN File | BDN
BDN File | BDN
Gov. Paul LePage, center, spoke with U.S. Health and Human Services Secretary Tom Price and Kellyanne Conway, a senior adviser to President Donald Trump, as part of a round-table on the state and nation's opioid addiction crisis.
By Alison Webb, Special to the BDN

Only one in 10 adults who need treatment for substance use disorder actually get it, according to the Substance Abuse and Mental Health Services Administration. We can do something about this.

The best way to get people the treatment they need is to expand access to MaineCare. And while we’re at it, we must rebuild our public health infrastructure so we have a foundation to support prevention and recovery in our communities.

Three recent developments may create enormous challenges to expanding health care coverage and funding public health initiatives.

First, Maine’s Department of Health and Human Services is planning to submit a Section 1115 waiver to the federal government that would reduce MaineCare benefits for some people. Section 115 waivers are opportunities for states to conduct pilot projects that are outside the usual federal Medicaid requirements. Maine Equal Justice Partners reports that under the DHHS proposal, a parent who is not pregnant or not disabled and has children 6 or older would only get only three months of MaineCare coverage in a three-year period, unless the person works at least 20 hours per week.

Second, the American Health Care Act, recently passed by the House of Representatives, will create enormous challenges to expanding health care coverage by changing the way the federal government supports Medicaid. According to the The New York Times, Medicaid cuts and changes will total $880 billion over 10 years nationwide. The AHCA will also reduce significantly federal funds available for prevention initiatives if approved by the Senate in its current form.

Third, the Trump Administration has proposed decreasing the budget of the federal Office of National Drug Control Policy by 95 percent. In Maine, ONDCP provides $2.25 million annually to 18 Drug Free Communities Coalitions, which are responsible for evidence-based prevention strategies in their communities.

This year, regardless of what happens at the federal level, Maine legislators will consider over 100 bills that address drug and alcohol use. More than 40 of these bills tackle some aspect of the opioid epidemic.

One bill in particular stands out because it underlines the importance of creating a solid infrastructure for prevention, treatment and recovery.

LD 812 directs DHHS to establish the Washington County Substance Use Disorder Pilot Project that would create a recovery-oriented system of care in Washington County.

The bill would provide detox beds, medication assisted treatment, residential treatment, counseling, child care, transportation, peer support and more for people with substance use disorder, including those without insurance. It would provide support for family members, and it would provide funds for evidence-based prevention programs in schools.

This bill’s significance is huge: It recognizes the importance of addressing substance use across the continuum of care, from prevention and early intervention to treatment to recovery. This is an evidence-based approach that should be in place in every county in Maine.

But a pilot project like this will fail because when the funding cycle ends, people without health care coverage will not be eligible for services. A comprehensive approach to substance use treatment and recovery is simply not possible without expanding MaineCare eligibility.

Our treatment system has been gutted by reduced reimbursement rates for medication-assisted treatment (mostly methadone), slashes to the number of people eligible for MaineCare and decisions not to expand MaineCare eligibility. Treatment agencies and health care providers have to pay the bills, and they can take only a small number of uninsured clients. State and federal treatment funds for the uninsured help, including for the recently approved “ opioid health homes,” but they don’t go the distance in delivering coordinated health care and recovery supports that are critical to wellness and recovery.

To be sure, pilot projects and other pieces of legislation to address the opioid epidemic are important. But if there’s only a rickety structure to hang new initiatives on, then we are set up for failure.

Mainers must act, and we have two important opportunities to do so. First, there will be public hearings this week on the Section 1115 waiver to reduce MaineCare benefits. One is at 9 a.m. on May 17 at the Cross Insurance Arena in Portland, and the other is at 9 a.m. on May 18 at the Augusta Civic Center.

Second, in the fall, we’ll consider a referendum to expand income eligibility requirements for MaineCare, and to require the state to provide services through MaineCare to eligible individuals under age 65. These changes will go a long way toward increasing access to substance use treatment for many Mainers.

We need a strong foundation to support prevention and recovery in our communities. The way out of this mess is to expand access to MaineCare and rebuild our public health infrastructure.

Alison Webb is a public health professional who has worked on community health initiatives, building Maine’s public health infrastructure, and substance use prevention, access to treatment and recovery supports in Maine since 2000.


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