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Long road to substance abuse treatment for N.H. Medicaid patients will soon be over

Regardless of whether state lawmakers decide this week to make more people eligible for Medicaid, officials have committed to making substance abuse treatment available for the first time to people already in the program.

The change means that for the first time in the state’s decades-old Medicaid program, participants will have access to treatment for addiction to alcohol and other drugs, which treatment officials say will save money overall by addressing the root cause of many problems.

“The potential impact on health care from an outcome standpoint and an economic standpoint is huge,” said Ken Norton, executive director of the National Alliance on Mental Illness, New Hampshire chapter.

“How many people end up in emergency rooms when there’s alcohol behind the situation, whether it causes a mental health incident or an accident or some other medical problem?” he asked.

“The impact (of substance abuse) on individuals and families and communities is terrible, and providing treatment for those folks is really key.”

The new addiction treatment coverage isn’t expected to start before December 2014, when the state enters the second year of its phased adoption of managed care, where the state pays a fee per person covered by Medicaid and the companies coordinate the individuals’ care and assume the risk that the care might cost more than the fees collected.

Earlier this month, Health and Human Services Commissioner Nick Toumpas confirmed at a meeting of the Medicaid Care Management Commission that the department will move forward with substance abuse treatment benefits for existing enrollees.

Gov. Maggie Hassan promised in her budget address in March to expand Medicaid participants’ access to substance abuse treatment and “continues to believe (it) . . . is the right thing to do for the health and well-being of our families, the productivity of our workforce, and the strength of our communities,” said spokesman Marc Goldberg yesterday.

Hassan and Toumpas’s commitment to moving forward is the culmination of a years-long roller coaster for substance abuse treatment advocates in the state.

The federal Medicaid program requires states to cover medically necessary inpatient detox treatment. All states except New Hampshire, Arkansas, Louisiana and Mississippi cover additional addiction treatments.

Since 2008, federal law has required increasing levels of insurance coverage for substance use disorders, including mandating coverage for people made newly eligible for Medicaid under the Affordable Care Act.

But a series of loopholes and exceptions left coverage for New Hampshire’s current Medicaid population to the discretion of the state.

Approximately 58,000 people in the state are eligible for expanded Medicaid under the Affordable Care Act. About 170,000 people are currently enrolled in any given year.

Adding the benefit to the program won’t require legislative action, only amendments to the contracts with the managed care companies, said Katie Dunn, associate commissioner of the Department of Health and Human Services.

Officials from HHS said they aren’t able to determine yet exactly how much the new benefit for existing Medicaid enrollees will cost, because they have not yet defined exactly what will be covered.

Substance abuse treatment contains a continuum of services from outpatient counseling to inpatient residential care.

Work to define the substance use disorder benefit package will be done between now and the end of the state fiscal year in June, Dunn said.

A budget estimate for Medicaid expansion included roughly $2,100 per person per year for substance abuse treatment.

States have experienced anywhere from $1.45 to $7 return on each dollar invested in substance abuse treatment through reductions in other health care costs, criminal activity and increased productivity, according to a report by the Lewin Group released in September.

“From a human perspective, people that have co-occurring mental health and substance use disorders are the people that have the poorer outcomes, and they’re the ones that are more likely to be hospitalized, more likely to be incarcerated, more likely to be homeless and more likely to die by suicide,” Norton said.

More than 64 percent of people admitted to New Hampshire Hospital for mental health treatment had a history of substance use, and 55 percent of them were actively using at the time of admission, according to a study of admissions in six months of 2012.

Forty-four percent of people released from prison in New Hampshire return to the corrections system, at least a third of them because of issues connected to substance use, according to the department’s 2012 annual report.

Exact predictions of how many people would use a substance abuse benefit if it were granted are hard to come by.

“What we know is that about 12 percent of the adult population of the state (about 125,000 people) experience problematic alcohol and drug use that would require some intervention,” said Amy Pepin, policy director of New Futures, a nonprofit agency dedicated to addressing alcohol and other drug problems in the state.

“What we also know to be true is that not everyone needs professional treatment to change from harmful drinking or drug use, and not all who need it would use it,” she said.

Whatever the increased demand is, it is likely more than the system can handle right now, said Tym Rourke, chairman of the Governor’s Commission on Alcohol and Other Drugs.

The state’s network of providers is able to treat between 4 and 6 percent of the people who need addiction treatment, he said.

“The existing provider community (has) been working really diligently, knowing and hoping this is coming, working to prepare, and they are nearing a place to be as ready as they can be,” he said.

“In most states where they’ve turned on a substance use disorder benefit, it’s not been a wave, not been a crush of people running to the door. It’s been a slow increase over time, so we think providers have time to continue the adjustments to their business model, at the same time these benefits can begin rolling out.”

“This is a disease, the nature of which is such that not everyone who has it seeks treatment, for many reasons, one of which is stigma,” Rourke said.

“Part of the hope is that treating it as a disease just like any other chronic health crisis will over time reduce stigma and drive people into treatment.”

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

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