Health reform could strain substance-abuse care

Klatzker
Klatzker

There are some things that don’t get better simply with time.
A substance-abuse problem, says Dale Klatzker, president and CEO of the Providence Center, a nonprofit that provides inpatient and outpatient services, is definitely one of them.
The Providence Center operates two treatment facilities, in Burrillville and in Cranston, that together provide 75 inpatient beds that are, Klatzker said, pretty much always full and have “long, long waiting lists.”
He’s afraid those waiting lists are going to get even longer when new health care laws that will expand eligibility for Medicaid take effect Jan. 1, 2014, and give previously uninsured adults better access to health care.
“I have been ringing the bell for a while that we’re not prepared,” Klatzker said. “It’s not going to take too much time for people who haven’t accessed care to want to access care to find that there isn’t a lot of care to be had.”
According to the U.S. Department of Health and Human Services, 100,952, or 12 percent, of Rhode Island’s nonelderly residents are uninsured. About 91 percent of those residents may quality to purchase insurance coverage in a health-insurance marketplace established under the Affordable Care Act or for Medicaid under the expansion, for which the state will receive 100 percent federal funding in the expansion’s first three years.
According to data collected by the Substance Abuse and Mental Health Services Administration, a total of 29,267 Rhode Island residents with drug and alcohol problems would be eligible for insurance when the new laws take effect. Those already seeking treatment put the state at a 90-95 percent capacity rate for its 322 nonhospital beds, according to the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
R.I. Health and Human Services Secretary Steven M. Costantino estimated that about half of those newly eligible for insurance would seek it out right away, which creates uncertainty about the impact the changes will have on the substance-abuse treatment system. But it’s better than the alternative of having people needing treatment but not seeking it, he said.
“You’re going from a whole bunch of individuals for whom one of the major barriers to seeking treatment or help [is not having] insurance or being underinsured.
“But we know that [not everyone] is going to walk in the door [immediately]. There will be a funding redesign in the state to be able to handle the gaps in treatment that Medicaid or commercial benefit is not covering,” Costantino said. Costantino is concerned about trying to profile the population newly eligible for treatment. It will be a difficult process because many are in the homeless population but also many are low-wage earners working in small businesses, he said.
Generally speaking, he said, it would be a strain to define the health status of those individuals because they’ve been utilizing the state’s health care system in “disjointed and segmented” ways, including emergency room visits.
“The potential stress is going to be on the outpatient system,” Costantino said. “You’re going to probably have [stress] on the detox system as well,” he said. “This is going to be a tremendous demand on counselors and professionals in the field.”
Klatzker agreed that Rhode Island does not have enough of a workforce to meet the needs of potential new patients.
“While on day one, these things might not occur, I keep on hoping, wishing, that there would be some investment now in anticipation of what [the system’s] going to look like,” he said. “If we wait to build this, we’ve just got a lot of problems in being able to pull off that kind of model with this population and the rates of reimbursement.”
Not everyone in the industry is as fearful of the system becoming overloaded.
Patrick McEneaney, regional director of Phoenix Houses of New England, said about 70 percent of that organization’s clients have a primary diagnosis of substance abuse.
Phoenix House has two residential facilities in the area with 72 adult beds and 21 for adolescents.
“One of the things we’ve learned over the years is that people in drug and alcohol rehabilitation are not the most functional, so we always have a bit of a wait list and we’ve built that into our scheduling,” he said. “We plan for no shows. We treat the people that we can treat effectively and those who are beyond our skill set we move to an acceptable [place].”
McEneaney suggests the state start tracking insurance codes after the new health care laws take effect to determine if more patients are seeking substance-abuse treatment, but he’s not expecting an onslaught of new patients. •

No posts to display