CLEVELAND, Ohio – Cuyahoga County Common Pleas Judge David Matia is a big fan of the Affordable Care Act, otherwise known as Obamacare, because it means a lot more of the defendants who come before him with addiction problems can get the treatment they desperately need.
It’s not necessarily the act itself that has bailed out indigent drug addicts, but the Medicaid expansion that came along with it in Ohio.
The surge in government-funded coverage has come at a time when Ohio and many other states are reeling from an opioid epidemic that has lead to a rash of overdose deaths, largely from heroin and newer synthetics such as fentanyl.
The problem has become so pervasive that a public-private partnership in Cuyahoga County has mounted a major public service campaign called “Know the Risks” to warn about the dangers of taking prescription opioids and to detail what is being done to curb their use.
While the focus of the campaign is prevention, the issue of treatment for addiction still looms large, although according to treatment advocates, it is beginning to get more favorable attention from private insurance companies.
And that’s a good thing, said Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services, because addiction can lead to a variety of other medical maladies that need costly treatment.
“As time goes on we’re seeing more progress in this area,” Plouck said.
Private insurance policies in general run the gamut of coverage, said Thomas Stuber, president and CEO of The LCADA Way, which operates drug treatment centers in Lorain and Medina counties. Medical Mutual “has been wonderful in terms of supporting rehabilitation” while others not so much, he said.
And the Affordable Care Act has not made private insurance that much more accessible for drug treatment, Stuber said, because private plans offered through Obamacare tend to have high co-pays and deductibles that exceed to cost of treatment.
Matia said that the better insurance policies provide initial detox and maybe up to 21 days of rehabilitation, but that’s generally not enough time to adequately treat someone’s dependence.
Stuber said Medicaid provides far more comprehensive coverage than private insurers. It will pay for treatment as long as it meets the criteria set by the American Society of Addiction Medicine, he said.
That’s important Stuber said, because adequate treatment can be lengthy as it may take 35 weeks for an addicted brain to “stabilize.”
However, limits on Medicaid coverage are to be imposed on July 1, Stuber said, as called for in the state budget. For example, someone who spends 30 days in a residential setting soon will have to get authorization for an additional 30-day stay, he said, “which mean somebody can say no.”
Also, partial hospitalization will require pre-authorization, whereas now it doesn’t, he said.
The changes also include turning over Medicaid to a group of five managed care companies on Jan. 1, 2018. Stuber said one of those companies, a non-profit called CareSource, does a good job covering drug treatment.
One big problem with Medicaid, according to drug treatment advocates, is the Institution for Mental Disease rule that prevents the government from reimbursing a drug treatment facility if it has more than 16 beds.
The IMD rule goes back to the 1960s when drug rehabilitation had a stigma to it and wasn’t seen as such a priority, Plouck said. The purpose of the rule was to keep mental institutions from housing people for long periods at taxpayer expense.
“The IMD rule is absolutely insane and it has nothing to do with insurance,” Stuber said.
Plouck said the federal government has relaxed the IMD rules to some extent, but because of the cost involved, it still won’t allow Medicaid to reimburse stays of longer than 15 days for facilities with more than 16 beds. Most residential stays for drug treatment are for longer than 15 days.
Matia said that if he were “the dependency czar,” he would do away with the Institution for Mental Disease rule and make sure that every hospital emergency room has a detox center.
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