As a member of the state’s Opioid Task Force, I have read scores of articles and reports. I have also listened to countless speakers and PowerPoint presentations. But the thing that I remember most after seven months of meetings was the simple answer to the final question posed to Portland Police Chief Sauschuck when he testified before us.
When asked what single thing the task force could do to best address the problems he was seeing with increased overdoses, arrests and crime related to untreated substance use disorder, he did not hesitate to answer, “Expand MaineCare.”
He was right.
There are other ways to address it, too, but simply expanding access to the state’s Medicaid program, known as MaineCare, to an estimated 80,000 people would be a huge step forward.
On the Nov. 7 ballot, Question 2 would authorize Maine to accept federal funding to cover 90 percent of the health care costs for low-wage earners who are currently not eligible for MaineCare. Determining eligibility is a complex process combining things like having low income and being elderly or having a certain diagnosis, or having low income while pregnant or raising children. Low income alone does not make one eligible.
Question 2 would open eligibility for so-called able-bodied adults with annual incomes at or below 138 percent of the poverty level. Many of these adults work hard, sometimes at several jobs, but are not offered health insurance through work. Many have started businesses, some employing others, but cannot afford insurance for themselves or their employees. Many others struggle with undiagnosed or untreated mental illness, a substance use disorder, or a co-occurring disorder, often ending up in emergency rooms and county jails. Some make up the more than one person a day dying of an overdose.
Under the Affordable Care Act, nearly 20,000 Mainers have gotten needed access to treatment for mental illness and substance use disorder, according to researchers from Harvard Medical School and the Wagner School of Public Service at New York University.
In a recent study of four states that expanded Medicaid — New York, West Virginia, Iowa and Washington — an estimated 13 percent to 35 percent of the expansion population were using or dependent on opioids. For Maine, that could mean that somewhere between 10,400 and 28,000 additional people might be able to seek treatment.
These states, and the other 27 states that have already expanded Medicaid, are receiving matching reimbursement for 90 percent of the cost of expansion from the federal government. Taxes from Maine residents are helping to pay for this expanded access, but not here in Maine.
In Maine, the administration negotiated with the Legislature to add $2 million to the supplemental budget for opioid treatment for the uninsured, which was a step forward, but it only expanded access to less than 200 uninsured individuals.
Only 200 versus the thousands who need treatment.
Maine cannot spend more of our state dollars without seeking the federal dollar match. The need is too great, and our people cannot afford it.
Maine representatives and senators realize this and have passed Medicaid expansion five times, but each time it was vetoed.
Investing in support systems for people in recovery from opioid use disorder, such as access to housing and community-based peer support is also essential to help sustain this recovery. The administration is moving forward on some of these initiatives, but without expanded access to treatment, these dollars will not go as far as they could.
We also need to make sure that MaineCare reimbursement rates are reasonable so that providers can continue offering these essential services in all of our communities. In the past few years, several providers have discontinued services such as medication management for people with serious mental illness or treatment for substance use disorder because they cannot be sustained given the current rates.
MaineCare expansion will add much-needed dollars to ensure healthier communities and healthier lives.
It is time to bring some of our federal tax dollars home. It is time to pass Medicaid expansion in Maine. Vote “yes” on Question 2.
Malory Otteson Shaughnessy is the executive director of the Alliance for Addiction and Mental Health Services and a member of the Maine Opioid Task Force.
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