State unable to measure how many addicts find recovery

Feb. 04--CONCORD -- The chief House budget-writer said he was alarmed to learn Friday that state officials are unable to say how many of the 10,000 substance abusers receiving Medicaid health insurance got into recovery or had overdoses after they were on taxpayer-financed assistance.

House Finance Chairman Neal Kurk, R-Weare, said it's important to note an estimated 104,000, or 8 percent of the state's population, have a substance use disorder that can be drugs or alcohol, but only 10 percent of them get health insurance benefits for that treatment under Medicaid.

"You don't know how many people go through treatment (and) are no longer in need of that service?" Kurk asked executives with the Department of Health and Human Services during a briefing Friday.

Behavior Health Services Director Katja Fox answered, "No I don't believe we know that."

Kurk urged state officials to develop the ability to track clients.

"We really need to know, of those 10,000, how many are in recovery and how many are repeat clients," Kurk said.

Fox responded, "Message received."

That was one of several pointed exchanges between members of House Finance and officials at HHS, an agency that consumes nearly half the state budget and has been dealing with an eight-figure deficit in the current budget year that ends June 30.

HHS Commissioner Jeffrey Meyers and his leading agency heads gave the key panel updates on Medicaid expansion, known as the New Hampshire Health Protection Program, as well as spending on long-term care and services for the developmentally disabled.

Medicaid expansion provided state-federal insurance for 53,000 low-income adults and the federal government required that the plan include coverage for substance abuse.

In response, the state extended substance abuse benefits to all 187,000 who receive Medicaid, including low-income, pregnant women, children, senior citizens and the disabled.

It was a pivotal move coming just at a time when New Hampshire was experiencing the crisis in opioid overdoses.

Medicaid Director Deborah Fournier said 82 percent of those on Medicaid making use of those substance abuse benefits have been opioid users.

State Rep. Bill Hatch, D-Gorham, said he understands why it's difficult to track whether those benefits are leading to permanent recovery.

"They are a population that is hard to measure. They are transient and they often do not report," said Hatch.

"We are dealing with life-and-death circumstances, so we also need to consider not just the outcome but what happens when these services are not available, and it is often the worst-case scenario."

Fox credited the Legislature with passing a new law last year that creates measurements for her agency to determine the success rate of providers that deliver substance abuse treatment.

"Yes, we are measuring, and that is something that is always a work in progress," Fox said. "We need to improve how we track data, but we are doing a better job."

A critical barrier to delivering more substance abuse services in New Hampshire is a workforce shortage and strict licensing requirements that limit who can deliver them, Fox continued.

"I think it is a nationwide shortage. We are going to have to look at really building the pipeline," Fox said.

Kurk said, as they did with physical health care, lawmakers need to change licensing laws to expand who can provide substance abuse and mental health care.

"We need to create new classifications for certification for less-trained people to do a lot of tasks, have nurses, CNAs (certified nurses assistants), LPNs (licensed practical nurses) enlisted to do those sorts of things," Kurk said.

House budget writers also learned the state continues to have a waiting list of developmentally disabled adults in need of services.

Lawmakers thought they had solved the two-decades-old problem with a state law to eliminate the waiting list in 2014.

Meyers said new cases emerge every year as disabled youths turn 21 and can no longer be enrolled as children.

Further, Meyers noted that more than half of the 166 on the waiting list as of Dec. 31 were getting some care, but had become eligible for more care due to changing circumstances, such as aging parents or becoming homeless.

"We are all living longer, as you know, including those for disabilities, and that's a good thing, but it also requires more resources to provide the care that people need," Meyers added.

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