New Hampshire funding for treatment, recovery far lower than neighboring states

Last modified: Wednesday, July 08, 2015
Sleep as long as possible. Find a way to get heroin. Use. Repeat.

The painful cycle was Lance Alonardo’s life, until the 26-year-old decided to seek out help at a treatment center in Franklin.

But the waitlist for one of the 13 beds at the state-funded facility was longer than a month. So over the next three weeks Alonardo added another task to his routine: calling the treatment center every day until a space opened up for him.

“A lot of people don’t end up lasting that long,” Alonardo said. “When people are willing to reach out and ask for help, it would be best if their hand were grasped as soon as possible because they may not have the strength to hold it up so long.”

Delays in receiving treatment, which have become a common reality for drug addicts seeking help in New Hampshire, can sometimes mean the difference between life and death.

New Hampshire ranks second-worst in the nation for treating people who need it, according to a 2011 Center for Behavioral Health Statistics and Quality report.

More than 100,000 people in New Hampshire meet the criteria for a substance use disorder, according to state officials. The publicly funded sector has the capacity to treat roughly 5,000.

With such a disparity between the number of people who need treatment and the state’s limited capacity to help, many people fighting addiction find the recovery stage out of reach.

The year after a record 326 people died from drug overdoses, state officials and advocates are calling for change.

“All we’ve done for the last 15 years is stick fingers in holes,” said Tym Rourke, who chairs the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery. “It’s why we are here.”

Now, aided by the Affordable Care Act, New Hampshire’s Medicaid expansion plan and the state budget, officials are working to redirect funds into developing treatment and early intervention capacity, recovery services, and prevention programs.

Officials liken the approach to a three-legged stool: if one area is lacking, the whole system collapses.

The waitlist Alonardo experienced is a product of a broken system, advocates and officials say.

Limited resources

New Hampshire has traditionally had very limited resources to deal with substance abuse, said Joe Harding, director of the state’s Bureau of Drug and Alcohol Services.

In 2014, New Hampshire spent $8.81 per capita on alcohol and drug services, the lowest amount in New England. The next closest state, Rhode Island, spent $14.32 per person, according to the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery.

Over the past 20 years, the Bureau of Drug and Alcohol Services has used most of its funding to contract with treatment providers in the state, subsidizing the cost of services for people who can’t pay.

A separate substance abuse fund created by the Legislature more than a decade ago and known as the Alcohol Abuse Prevention and Treatment Fund has been fully funded just once. Most of the money has been used to subsidize treatment services, which is the process of detoxing from drugs and alcohol.

Little state money has been left over for recovery, early intervention and prevention programs. And that’s led to a substance abuse system in New Hampshire that lacks a full range of services and has the capacity to help only a small fraction of those facing addiction, officials say.

“You could build all the treatment in the world and reduce wait times to zero. It won’t solve the problem,” Rourke said.

If people get out of treatment and can’t find recovery support that helps them stay sober, he said, their risk of relapse is high.

On the other end, officials say, prevention and screening programs are critical to catch addiction early on before it even begins, when people require less expensive care, and have a higher chance of successful recovery.

“If you don’t close the spigot on the number of people becoming addicted, we will never get ahead of this,” Harding said.

Changes are coming

Officials view the state’s Medicaid expansion efforts coupled with the Affordable Care Act as a way to free up some state funds to pay for recovery and prevention services.

At the same time, the budget offers a boost in state funding for substance abuse services. But as promising as the changes appear to advocates and officials, they remain vulnerable to politics.

People who qualify for expanded Medicaid – adults making less than 138 percent of the federal poverty limit, or about $15,900 a year – can now use insurance to access substance abuse treatment in New Hampshire. State officials estimate 14 percent of the expanded Medicaid population will access those benefits. Under the Affordable Care Act, all insurance providers have to provide substance abuse coverage.

The change marks a big shift from the past. New Hampshire will still subsidize treatment costs on a sliding basis for people who fall between 139 and 400 percent of the federal poverty level.

But now that a large chunk of the low-income population can get insurance coverage under expanded Medicaid – and no longer needs state subsidized treatment – officials hope to begin reallocating some of those state dollars to recovery support, prevention and treatment infrastructure.

“All of that is leading to better resources to pay for treatment,” Harding said. “We still need to develop capacity.”

All of that, of course, hinges on the future of Medicaid expansion. The health care program is set to expire in 2016 unless state lawmakers vote to reauthorize it. Top Republican lawmakers have said they don’t want to debate the program until next year, when they have a better sense of how it’s working.

The state also has to begin paying for the program in 2017, when federal funding begins to drop off. Republican budget writers didn’t include the $12 million price tag in the state spending plan.

Tied up money

The state budget offers another area of change for substance abuse.

Lawmakers included $6.6 million in the state budget to expand substance abuse benefits to the state’s traditional Medicaid population for the very first time.

The Legislature also opted to double the money going to the state’s Alcohol Abuse Prevention and Treatment Fund, used for substance abuse services and overseen by the commission Rourke chairs.

Although less than the expected $17 million, the two-year state budget would double the fund’s balance to $6.7 million. The commission hopes to use that additional money to pay for recovery programs, that unlike treatment services aren’t as easily reimbursable by insurance.

Democratic Gov. Maggie Hassan vetoed the state budget, saying it promises more than it delivers. Now, New Hampshire is operating under a six-month temporary spending plan that funds the state at current levels while lawmakers come up with a compromise. That means the Alcohol Abuse Prevention and Treatment fund has yet to receive its expected increase and the commission can’t begin deploying the new dollars.

But some lawmakers question the tangible benefits of increased spending on substance abuse.

“The assumption always is money equates to results, in the case of substance abuse that’s debatable,” said House Finance Committee Chairman Neal Kurk, a Weare Republican.

Moving forward, he said, the state should be providing lawmakers data showing the effectiveness of substance abuse programs and how the state’s investments have affected outcomes.

“Results doesn’t mean a survey that says, ‘Did you enjoy the program?’ ” he said. “We’re talking about visible results and behavior that’s permanently changed.”

Harding says outcomes are predictable. The state contracts with facilities that follow evidence-based practices, demonstrated through federal studies to be effective. It means the state can expect the success of treatment to be on par with other chronic diseases, roughly 60 to 65 percent.

The average cost to treat someone in New Hampshire is $1,600, Harding said. The state’s investments in prevention, treatment and recovery, he said, will help keep people from starting with drugs, intervene early before people’s substance abuse becomes a serious problem, or treat people effectively when they are addicted.

“All of those things collectively are a small fraction of the cost to the state of New Hampshire that is related to the misuse of alcohol and drugs,” Harding said. One study commissioned by the advocacy organization New Futures puts the cost to New Hampshire at $1.8 billion annually, in lost productivity and earnings, increased spending on health care and public safety costs.

Even with the best-laid plans, officials say, there’s no overnight fix for an issue that has plagued the state for years.

“For people that are in the throes of addiction, facing these problems, there are really no easy answers for them,” Harding said. “We need to do better.”

When Alonardo left the Franklin treatment center, he moved straight into a Northfield sober house, where he lived for a year with a dozen other men also in recovery.

It was a very different experience from the first time Alonardo went through a treatment program in Michigan. Then, he returned home to his same life, his same friends and very quickly, his same addictions.

The sober house in Northfield helped Alonardo learn to be in recovery. It’s a lifestyle he has maintained for the past year and a half.

“I owe an unrepayable debt to the people who helped me,” he said. “I strive to help other people in recovery and help them maintain or achieve that.”

(Allie Morris can be reached at 369-3307 or amorris@cmonitor.com or on Twitter @amorrisNH.)