A dramatic change in how Maryland pays for substance abuse treatment programs is leaving some providers short on cash and displacing more than 200 drug and alcohol addicts, even as the state's four-year transition to a new funding system has significantly increased the number of people getting help.
Providers say they're worried that the instability will cause recovering addicts to lose their tenuous grip on sobriety when at least three treatment centers close their doors this summer, as the facilities deal with the unintended consequences of a state effort to broaden services.
But Susan Tangires, director of Epoch Counseling, said the nonprofit learned "essentially overnight" that it would have to close its Lansdowne center, eliminate five full-time positions and shuffle some 90 clients to its Catonsville clinic. Counselors at the Lansdowne office are tapering off services and expect to close the center by August, Tangires said.
Even though the distance between Epoch's Lansdowne and Catonsville centers isn't far, Tangires said the change could be a major deterrent to those in recovery.
"Anything that makes it a little harder, you stand the chance of losing that person," Tangires said.
Under the new system, the state will pay for more treatments through Medicaid reimbursements, a strategy that officials say will ultimately provide health care access to more Marylanders. Medicaid is the federal health insurance plan for the poor and disabled, and every state dollar is matched by Washington.
By some measures, the state's new strategy is already showing success. Nearly 20,600 more people are getting addiction help today than three years ago, state officials said.
Many addiction specialists agree that the move will eventually help more people, but right now they're trying to find ways to keep displaced clients in treatment. They knew the funding shift was coming, but few realized it would arrive so quickly. Now, centers are facing the loss of millions of dollars in grants.
First Step expects to close its Randallstown and Towson treatment centers this week and shift its clients to its Reisterstown and Cockeysville locations. The drug treatment program at Sinai Hospital is scaling back its services, and Gaudenzia's residential treatment center in Owings Mills may have to shut down.
The idea behind the funding change is that facilities would make up for the cuts by billing Medicaid, but providers say they're not able to recoup all of the money they lost. For instance, providers cannot bill Medicaid when an addict does not show up to a scheduled appointment, a regular occurrence that skews budget projections and curbs cash flow.
Kathleen Rebbert-Franklin, acting director of the Alcohol and Drug Abuse Administration, said providers must become less reliant on grant funding, and many have already done so. The state should not be paying for treatment that qualifies for Medicaid reimbursement, she said.
Rebbert-Franklin said the announcement of the change in 2008 was intended to give providers time to adapt.
Tangires said Epoch decided to consolidate the Lansdowne and Catonsville centers after learning in mid-May that it had six weeks to figure out how to juggle a more than $286,000 budget cut from the state effective Sunday with the start of the new fiscal year.
Frank Arthur, a 44-year-old mural and graffiti artist from Halethorpe, said counselors in the Lansdowne center are the reason he is sober today, 28 months and counting.
"These people are like my family, even when my own family didn't want to be around me," Arthur said recently from the lobby in the center. "So many people threw me away, or threw me in jail. This place right here was the foundation. I would be under a bridge somewhere in or in jail."
Arthur said he used cocaine, LSD, heroin and marijuana for 25 years. His counselor at Epoch "breathed new life into me," Arthur said. He rides his bike the two to three miles from his home to Epoch's Lansdowne office at least once a week to meet with the counselors and finds Narcotics Anonymous meetings to attend daily.
After the Epoch center closes, his bike ride to see the counselors will more than double, but he plans to keep it up.
The budget cuts varied by jurisdiction.