Substance abuse crisis could shape Medicaid expansion debate

CONCORD, N.H. — As lawmakers prepare for next year's political battle over Medicaid expansion, supporters said the state's ability to tackle a growing drug abuse problem will be dramatically reduced if the program comes to an end.

"Medicaid expansion kind of allowed substance misuse providers to go from 0 to 60 from a service standpoint," said Abby Shockley, executive director of the New Hampshire Alcohol and Other Drug Service Providers Association.

Unlike traditional Medicaid, the expansion program covers a variety of substance abuse treatment and recovery programs. Providers say the Medicaid money now coming in is helping them respond to a growing need for services. But the program is set to expire at the end of next year if lawmakers don't vote to continue it. With more than 320 drug deaths in the state last year, Medicaid expansion's effect on treatment and recovery programs is likely to become a central part of the debate.

"Expanding treatment is an urgent need," Gov. Maggie Hassan said Monday at the groundbreaking ceremony for a new treatment facility in Franklin. "We have providers who tell us they are ready to expand if they knew Medicaid expansion was happening and was going to be fully authorized and permanent."

Expansion took months of negotiations between Republicans and Democrats throughout 2013 and into 2014. A bipartisan group of six senators, including the Republican Senate president and majority leader, crafted a deal that requires lawmakers to reauthorize the program when federal funding starts to dip below 100 percent. More than 40,000 people are now insured under the program, and it's estimated to cost the state about $12 million for the first half of 2017.

Senate Majority Leader Jeb Bradley said he'd like to continue the plan if lawmakers can show it is working and if it can be paid for without state tax dollars. He said the increased focus on the heroin crisis will be part of the discussions.

"This year, it's reached the public consciousness and as a result I think it's front and center in everybody's mind," he said.

In the past, providers who helped low-income residents received aid through federal block grants at a rate of about $130 per patient per day. Medicaid expansion ups that to roughly $160 per day for in-patient residential treatment programs. New Hampshire's Medicaid expansion plan covers screenings, counseling and a number of other treatment and recovery programs. Between September 2014 and March 2015, roughly 1,800 people insured by Medicaid expansion accessed substance abuse services.

The extra money matters, providers said.

"It makes a difference (when) making decisions about providing services long-term (and) being able to afford to do that," said Karen Van Der Beken, chief development officer for care provider Easter Seals.

There are 228 licensed treatment beds in the state and more than 100 are in the licensing process, according to Hassan's office.

To bill Medicaid, providers of in-patient residential treatment must meet a litany of building code requirements and three major providers are struggling to do so. Other providers may need to retrain staff, hire more workers or make other adjustments to meet Medicaid requirements, Shockley said. If the increased money from Medicaid expansion goes away, providers who make these changes could be left with costs they can't afford.

"I have nightmares about this," Shockley said. "I just honestly don't know how the system wouldn't completely collapse."

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