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Editorial: For substance abuse treatment, a ray of hope

In the years and decades to come, we will no doubt marvel that it was ever any other way. But the state government’s plan to start including substance abuse treatment among the other, basic medical services covered by Medicaid is, for New Hampshire, revolutionary.

As health care reporter Sarah Palermo wrote in yesterday’s Monitor, regardless of this week’s political struggle over whether to dramatically expand eligibility for the government-subsidized insurance program, New Hampshire intends to meet a goal articulated by Gov. Maggie Hassan in her budget address last year. For those patients already enrolled in Medicaid (about 170,000 people), coverage for alcohol and drug addiction treatment will begin probably late next year.

Why have such treatments been segregated in the past? No doubt the cause was a combination of stigma – drug abuse is still often considered a moral weakness rather than a medical ailment – and pound-foolish budgeting on the part of generations of politicians. But the cost – in both human and financial terms – has been significant.

The effects have been easiest to track in the state’s corrections and mental health systems. The bad acts that land inmates in jail or prison often have drug or alcohol addiction as a contributing factor: erratic, dangerous behavior and the desperate need for cash to finance their habits. And their inability to get treatment on the outside no doubt plays a significant role in New Hampshire’s high rate of recidivism.

Among psychiatric patients, mental illnesses are often accompanied by addiction. But because Medicaid wouldn’t generally cover both troubles, the neediest patients’ ability to recover and lead productive lives was vastly diminished.

Less visible is the impact on everyone else: New Futures, an advocacy group on addiction issues, estimates that of the 113,000 residents who need treatment for alcohol and other drug disorders only 6,000 are able to get needed treatment. And a 2012 report on the impact of alcohol abuse in the state included this provocative conclusion: “Alcohol treatment and prevention is likely to have a greater long-term economic impact than nearly all other strategies to improve the performance of the New Hampshire economy.”

There are still many questions to be answered. Precisely what sort of care will be covered? How quickly will health-care providers see a rush of new patients? How quickly will health-care practices gear up to serve them?

There is irony, too, in this development. Back in February, when Hassan outlined her plans to cover substance abuse treatment for Medicaid patients, she framed it in the context of the proposed expansion of Medicaid eligibility. The federal government was requiring such coverage for the expansion, and so, Hassan argued, it only made sense for the state to offer the same to existing Medicaid patients. “This parity is smart and it is right, and so this budget provides for mental health and substance abuse treatment coverage for our existing Medicaid population as well,” she said.

Nine months later, the Legislature still has not committed to expanding Medicaid eligibility, and the outcome of a vote in the Legislature tomorrow is uncertain. As a result, the expanded alcohol and drug addiction treatment may not go nearly as far as the governor envisioned.

As with most things in New Hampshire government, progress can be achingly slow.

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