With the U.S. Senate set to consider a new iteration of the repeal-and-replace heath care bill, a key concern remains how deep cuts in Medicaid funding will impair efforts to stem drug addiction.
The opioid epidemic continues to grow, but there have been some hopeful developments recently in Indiana's efforts to deal with it. Those include Gov. Eric Holcomb's announcement last week that Indiana Medicaid will add methadone to its list of approved treatments for addiction, and that the Bowen Center will be among five new state-approved treatment centers. (See Dr. Jennifer Walthall's column on Page 7A.)
But if deep Medicaid cuts are part of whatever health care law emerges, and if Indiana is not willing or able to make up the shortfalls, vital substance-abuse programs would be imperiled.
“Here is the part that many people do not know,” Paul Wilson, CEO of Park Center, said in an email last week. “The people with addictions will be among the hardest hit.”
The Affordable Care Act that established Obamacare and expanded Medicaid, led to the creation of HIP 2.0, which allowed Indiana to extend coverage to many poor people who couldn't previously qualify for Medicaid services. Medicaid, which mainly provided services to single mothers and their children, the disabled and the aged was expanded to offer health care to others too poor to purchase medical insurance. Now those covered under HIP 2.0 include thousands of Hoosiers with substance-abuse problems who never before could have qualified for addiction services.
At Park Center, 55 percent of those who receive substance-abuse treatment are covered by Medicaid, Wilson said, and most of them became eligible because of income. There is more progress on the horizon. “In Indiana,” Wilson wrote, “there have been very few residential addictions programs because ... there was no pay source.” As part of its proposal to renew the waiver that allows HIP 2.0 to distribute Medicaid funds, the state plans to add residential treatment coverage to HIP 2.0 next February. But, Wilson said, “at a time when the opioid problem is out of control and providers are opening residential addictions programs, the pay source for those programs is in severe jeopardy.”
As The Journal Gazette's Niki Kelly reported Friday, Gov. Eric Holcomb is closely tracking how the health care bills in Washington may affect Indiana finances. But his press secretary, Stephanie Wilson, told Kelly the governor's office would not commit to releasing such estimates until after there's a vote on health care.
Unofficial predictions, though, are unnerving. Indiana Sen. Jim Merritt said in an interview Friday the state could be faced with making up some $300 million per year. Other estimates are even higher.
While possibly trying to make up such shortfalls, the state will need to find even more money to deal with addiction.
“I still believe Indiana has a quarter-of-a-billion-dollar (a year) problem,” Merritt said. “It hasn't crested yet. We're losing.”
Merritt, the Indianapolis Republican who has led the legislative effort to address addiction, points out there are other sources of support for some of the programs under way. Those include $10 million budgeted by the state this spring and $10.9 million Indiana is receiving from the federal21st Century Cures Act Congress passed last year. There's also the prospect that a national health care bill will include a dramatic infusion of funds – perhaps $4.5 billion a year, split among the states – to deal with opioid abuse. Critics are saying that won't be enough to deal with the problem; Wilson said such direct grants might simply “backfill” some of the losses in Medicaid support.
The numbers are dizzying and the costs are numbing. But people's lives are at stake. Congress needs to tread carefully on health care policy for so many reasons, but none more compelling than the urgent need to adequately fund addiction treatment.