The LePage administration’s $4.8 million plan to provide substance abuse treatment to more than 400 Mainers affected by the opioid crisis has so far resulted in five uninsured people and fewer than 50 Medicaid recipients receiving treatment.
Less than $60,000 has been spent so far on the Opioid Health Home program almost a year after it was launched, according to a Feb. 6 memo from the Maine Department of Health and Human Services.
At the time, the LePage administration touted the program as a major step forward in addressing the opioid crisis, although critics called it a half-measure at best. Other bills that would have expanded access to treatment, including one by Rep. Karen Vachon, R-Scarborough, died in last year’s legislative session.
An average of about one Mainer per day is dying of drug overdoses, mostly fueled by the opioid epidemic. Overdose deaths – 376 in Maine in 2016 and 185 through the first six months of 2017 – now outpace car crashes as a cause of death.
“Here we are a year later and it has not worked. The model they were promoting is not usable,” said Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, Maine, a trade group representing providers. “Money is left sitting in a bank someplace instead of people getting the services they need in the real world.”
A DHHS spokeswoman did not respond to a request for comment Thursday afternoon.
Shaughnessy said the LePage administration has been weighed down by bureaucracy and is not willing or able to work with the providers that are the experts in delivering care to those needing substance abuse treatment.
“They’ve helped five uninsured people in one year, and Milestone turns away 10 people a day,” Shaughnessy said, referring to Milestone Recovery, a treatment program in Portland that has to turn people down because Maine’s system doesn’t have an effective way of delivering care to the uninsured. “Those are the real numbers.”
The $4.8 million plan, a blend of state and federal money, would have provided for about 170 uninsured Mainers to gain access to treatment, together with some 230 Medicaid recipients.
It’s unclear how many Mainers need opioid treatment but don’t have access to it, but treatment experts say the number is in the thousands. Many people with a substance use disorder lose their jobs and are uninsured as their lives spiral downward. Meanwhile, the LePage administration has tightened Medicaid eligibility for adults – a pathway to treatment because Medicaid reimburses for substance use treatment programs.
Shaughnessy said that in some ways the Opioid Health Home program was duplicative, because Medicaid recipients already have access to opioid treatment, which is typically medication-assisted treatment using Suboxone or methadone. The program would have done some good for the uninsured population, but even that part of the program has been unable to launch.
The DHHS memo says that “the department has sent out for signature an additional nine contracts for (Opioid Health Home) services, which would allow providers to serve up to 144 more uninsured individuals.”
“I don’t see them getting their help anytime soon,” Shaughnessy said.
Maine voters approved Medicaid expansion by a wide margin in November, and once the expansion is implemented, it will open up treatment access to many thousands of Mainers. About 70,000 Mainers will become eligible for Medicaid, although it’s unknown how much of the expansion population will need substance use treatment.
However, Republican Gov. Paul LePage has raised concerns about funding implementation, arguing with Democratic lawmakers over how expansion should be paid for. Shaughnessy said she expects the Medicaid fight will continue, and it will be up to the next administration to implement expansion.
LePage’s term ends in January, and the gubernatorial election will be held this November.
Shaughnessy said reimbursement rates are low for the services that DHHS requires of the providers in Opioid Health Homes, and the administration has not listened to feedback warning that the program wouldn’t work. The memo lists 18 approved Opioid Health Home sites across the state, including locations in Augusta, Bangor, Biddeford, Calais, South Portland, Lewiston, Portland and Waterville.
Dr. Noah Nesin, vice president of medical affairs at the Penobscot Community Health Center in Bangor, said that cumbersome rules, low reimbursement rates and red tape have all contributed to providers so far taking a pass on the program.
“One-quarter of our patients don’t have insurance and could use the Opioid Health Home services if we could ever get it going,” Nesin said. “The demand is certainly there.”
Rep. Patty Hymanson, D-York and House chairwoman of the Legislature’s Health and Human Services Committee, said the LePage administration is “overwhelmed” by the opioid epidemic and unable to execute its plans.
“We have a tsunami of a problem with access to treatment and the department’s efforts have been cautious and underwhelming,” Hymanson said, adding that the committee planned to discuss the report at a future meeting.
Joe Lawlor can be contacted at 791-6376 or at:
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