As the opioid crisis takes hold, Howard County's only outpatient clinic for those with substance abuse disorders who are Medicaid recipients or uninsured will close on Dec. 31.
Roughly 750 of the clinic's clients will move to community care providers as the state phases out grant funding for clinics run by local health departments and transitions to a fee-for-service model that pays health care providers for each service provided.
The shift, pushed by 2014 legislation as the state embraces an integrated system of care, reimagines health departments' roles from service providers to local authorities that oversee and manage treatment. Some jurisdictions have already transitioned their clinics. Anne Arundel County, however, is trying to continue providing in-house services.
Maura Rossman, health officer of Howard County's health department, said the department anticipates meeting the needs of most clients.
"We are hopeful that as we transition our clients to providers, there will be capacity to provide the services they need," Rossman said. "We don't know yet. The unknown is always a little nerve-wracking."
The department has been preparing for the transition for more than a year. Rossman said the health department decided against maintaining the clinic because low reimbursement rates and maintenance costs were too high.
The transition also allows the health department to avoid a "conflict of interest," Rossman said. Under the current model, the health department oversees the quality of service provided throughout the county — a role that includes overseeing itself, local county officials said.
Finding immediate care for substance abuse disorders, which often requires care for mental health issues, is challenging, local health officials said.
Unlike neighboring jurisdictions, the county has no dedicated residential detox facility.
Low reimbursement rates hamper some community providers from providing care, local health officials said.
"It's a known problem," Rossman said. "Even for residents with commercial insurance it can be difficult to get a timely health appointment, especially with a psychiatrist. I worry about any time we have a delay in treatment."
A proposal by state Sen. Guy Guzzone to increase reimbursement rates to the average annual percent change of the consumer price index for medical care failed in the General Assembly this year.
The change would have cost the state $17 million in fiscal year 2018, according to state analyses.
The state's Department of Health and Mental Hygiene has been working with local jurisdictions to manage the transition and identify community providers, said Barbara Bazron, executive director of the state's Behavioral Health Administration.
"This is really a significant change in progress. It takes time to move toward a new order of things," Bazron said.
Allowing local jurisdictions to manage providers gives local health departments more control in identifying community-specific needs, Bazron said.
"In terms of developing and managing a system, it is best done at the local level where the jurisdictions know the needs of their community and can address the needs of their community," Bazron said.
Rossman said the health department will monitor whether community providers will be able to provide a continuum of services to meet individual's needs.
"As we no longer are in the direct care business, our role will be to oversee the services that are provided to publicly insured and hopefully insure quality and the capacity of services," Rossman said.
Health department counselors are helping clinic clients get referrals for community providers.
"I suspect there are many more who are untreated and continue to seek treatment. We're not done until everyone who needs treatment has treatment," Rossman said.
The health department will continue to provide some outpatient treatment at the county's detention center in Jessup, among other services, according to Roe Rodgers-Bonaccorsy, director of the department's Bureau of Behavioral Health.
This story has been updated to remove an accompanying photo of Silverman Treatment Solutions, a privately owned medication-assisted treatment program located on the grounds of the Howard County Health Department. Silverman Treatment Solutions is not scheduled to close.