Out of the dark: Insurance policies, funding among obstacles in affording treatment

June 28--Denise Holden, the founder and CEO of The RASE Project, minces no words when she talks about a future in which drug treatment programs continue to be underfunded.

"The prisons will get fuller, and there will be lots of business for the funeral homes if it continues this way," she said.

The RASE Project, which provides professional and peer-based recovery support services, was born out of a need for advocacy for those seeking treatment, Holden said.

Prior to starting The RASE Project, Holden was a clinical supervisor for drug and alcohol programs. Around 1990, when insurance companies began using the health maintenance organization and managed care organization models, the companies started denying treatment to addicts. She said she would get on the phone every few days, asking for another three to seven days in treatment for an addict, to which the company representative would respond that the client didn't need more treatment.

Holden said she lost the battle nine times out of 10.

"Now, if someone wants to get clean, they have to get on the phone and bargain with their insurers," she said.

Insurance companies fight addicts when they initially seek treatment, Holden said. Or, the policies at insurance companies are designed so that an addict has to fail at outpatient treatment before they can get more intensive levels of treatment.

If policies are in an addict's favor, the financial requirements may not be.

People with private insurance may have a deductible as high as $6,000, which represents a heavy burden to someone seeking help with their addiction, said Patricia O'Donnell, clinical director of drug and alcohol services at Diakon Family Life Services. Some have even turned away from treatment.

"That movement is going to cause more people to not be able to access treatment," O'Donnell said.

O'Donnell has a quick response to those who pose the argument that addicts who found money to purchase drugs should be able to find the money to pay for their treatment to detox and recover from the addiction caused by those drugs.

Yes, they found that money, she said, and they have robbed people, stolen items, prostituted themselves and done things for which they are not proud to pay for the drugs to feed their addiction.

"Do we want to set them up to do the same things (for treatment)?" O'Donnell said.

Medical assistance

Medical assistance has increased along with the demand for treatment services because the state has an obligation to cover those costs, said Jack Carroll, executive director of the Cumberland-Perry Drug and Alcohol Commission.

"That's good, but not everybody qualifies for that assistance," Carroll said.

There also aren't enough providers willing to see clients on medical assistance.

"The hard part is that there are a lot of providers who shy away from taking medical assistance," O'Donnell said.

In between the populations of addicts who qualify for medical assistance and those with private insurance are addicts who are often characterized as the working poor.

The Cumberland-Perry Drug and Alcohol Commission provides a range of public-funded prevention, intervention services and treatment options for them, Carroll said.

"Our funding is intended for folks who don't have other resources," Carroll said.

The commission offers its services on a sliding fee scale, which means that it analyzes a client's income to determine what they will pay. The client could pay up to half of the cost of treatment.

Some of the funding for the commission comes through the federal government, which is channeled through the state. The commission receives state funding from three different agencies. Most of the state funding comes from the state Department of Drug and Alcohol Programs, but treatment funding also comes from the Department of Public Welfare and additional funding comes from the Pennsylvania Commission on Crime and Delinquency.

"The reason for that is there is such an overlap between substance abuse and criminal behavior," Carroll said.

The majority of addicts do not break the law, Carroll said, but 70 percent of those incarcerated in state and county facilities have a drug or alcohol problem that led directly to the actions that landed them in the facility.

Cumberland County Prison, for example, had 428 offenders go through detox while incarcerated in 2011. Of those, 269, or 62.9 percent, were detoxing from opiates. The number of inmates going through detox in 2013 was 702 -- 466 of whom, or 66.4 percent, were detoxing from opiates.

State funding

As the use of opiates has increased over the past decade, state funding for substance abuse treatment has declined.

From the 2004-2005 fiscal year to the 2012-2013 fiscal year, funding from the Department of Public Welfare to the commission was reduced by 26.6 percent from $523,932 to $384,574. Carroll said the level stayed the same in the 2013-2014 fiscal year, but the funding for the 2014-2015 fiscal year is still up for debate.

Gov. Tom Corbett has done a "good job" recognizing the opiate problem as an epidemic, and is addressing it through policy initiatives, Carroll said. He had hoped that would translate to additional funding, but the proposed funding prior to the current budget negotiations had remained flat. With tax revenues coming in lower than expected, Carroll said he's now "fearful" the legislature may look to further cuts to human services programs.

There have been years when funding for inpatient non-hospital substance abuse treatment placements has been exhausted well before the end of the year, causing a moratorium on critical inpatient rehabilitation placements at a time when the need for public-funded treatment is greater than ever, Carroll said.

"At different points in time, we simply have more funding," he said.

Carroll said the commission always makes sure to hold enough money back for detoxification, but it has run out of money for rehabilitation services.

"Nobody should just receive detox," Carroll said.

Carroll said it's important for the public to understand that addiction doesn't just disappear if it isn't addressed. It shows itself as a major cost driver in other segments of the community through increased demands on police, courts, prisons, probation and parole, hospital emergency rooms, child welfare services, domestic violence services, mental health crisis programs and other social services, he said.

And, he said, research indicates that $7 in savings is realized in these areas for every dollar spent in substance abuse treatment.

"The funding problem is inescapable," Carroll said.

___

(c)2014 The Sentinel (Carlisle, Pa.)

Visit The Sentinel (Carlisle, Pa.) at www.cumberlink.com

Distributed by MCT Information Services