Drug testing for welfare faces hurdles Addiction treatment programs in short supply, experts say; Churches are opposed; Md. would deny benefits under Assembly proposal

THE BALTIMORE SUN

A legislative proposal to test welfare applicants for drugs has quickly encountered serious obstacles: Not only are treatment programs filled up, with long waiting lists, but the plan depends on the participation of religious leaders who are infuriated by it.

As if that weren't trouble enough, the idea took state and city health and welfare officials by surprise. They first heard about it Tuesday, when the General Assembly's Joint Committee on Welfare Reform said it would recommend something no other state has done: testing all welfare applicants for drug use and denying them benefits if they refuse treatment or return to drugs.

"I'm afraid the program is moot from the beginning," Dr. Peter Beilenson, Baltimore's health commissioner, said. "We have 5,700 slots, and we could only estimate how many people are trying to get in.

"My guess is it's probably 30,000 in a given year."

The Rev. Douglas Miles, pastor of Koinonia Baptist Church in Baltimore, called the proposal the "height of social engineering" because if a parent refused treatment, it would cut off her portion of the welfare payment and require a third party such as a church to accept the child's portion and spend it for the family.

"It assumes that just because you're poor means you're taking drugs," he said. "To ask the church to be part of this despicable effort is outrageous. The church community will stand united and opposed to it."

Legislators, hearing the complaints about shortages of treatment, promised to push to expand treatment programs.

"I would not support a change in law unless we have appropriate treatment available," said Del. Samuel I. Rosenberg, a Baltimore Democrat and co-chairman of the welfare reform committee. "The whole point is to help people."

If Maryland does require drug testing, it will be setting foot on terrain that until now has been considered risky, an area written off as promising too little return for too much investment.

But state Sen. Martin G. Madden, a Howard County Republican, says there is no choice if the state is to comply with the five-year limit on welfare benefits imposed by the federal government. He hopes the state can expand treatment as it moves welfare recipients into managed-care health plans.

Others are doubtful that sufficient treatment can be found. "Unless Maryland is in a different country than any other state," said Michael Laracy, who studies welfare reform for the Baltimore-based Casey Foundation, "treatment is woefully inadequate."

About 87,000 people throughout Maryland received drug-abuse treatment at public and private facilities last year, according to the state health department. That's about one-third the number thought to need services.

Beilenson calls drug abuse the biggest public health problem in the state and the goal of requiring treatment in return for a welfare check a laudable one. "Appropriate treatment does work, and it's not money wasted," he said. "The problem is, statewide, we do not have enough treatment slots."

The city has about 50 treatment programs. Half of the 5,700 slots -- which serve about 17,000 people because of turnover -- are in methadone programs. Methadone satisfies the craving for heroin but does not cure the addiction. The other half are in "drug-free" programs that attempt to get people off drugs through counseling.

A small number of patients are in residential treatment programs.

Karen Ostrich, director of the Man Alive methadone program in South Charles Village, said the program was always at capacity.

"Once you tell people there's a six- to eight-week waiting list they very often hang up the phone," she said. "The minute they want treatment, they want it that day. You should be able to offer them treatment right away."

In Maryland, under what has been Aid to Families with Dependent Children, about 63,000 adults and 140,000 children receive monthly benefits totaling $23.6 million. Legislators estimate that about 10 percent of applicants would test positive for drugs and about 5 percent would accept treatment, which they expect would come through managed care.

"One of the concerns, however, is the level of treatment that will be authorized," said Thomas Davis, director of the state's Alcohol and Drug Abuse Administration. Managed-care groups have been criticized for paring down substance abuse programs. "If it is not sufficient, people will still be left with a drug problem that must still be attended to."

Other states have rejected drug testing, either because it's not cost-effective or because of philosophical aversions.

One of those is Oregon, which Maryland welfare officials plan to consult because it is considered a national leader in reform, having reduced its caseload by 35 percent in the past two years.

"We made a conscious decision not to test everyone for drugs," said April Lackey, Oregon coordinator for drug and alcohol services. "It wasn't because it was too expensive. It was because we're here to help families."

Instead of drug tests, Oregon relies on screening, provided by a contractor, to turn up patterns that indicate alcohol or drug addiction. Case managers meet frequently with clients, and intensive contact reveals problems.

"We address drug and alcohol as barriers to employment," said Kevin Agurie, Oregon's Job Opportunities and Basic Skills manager. "It's all geared toward removing barriers, not toward removing eligibility."

The Maryland proposal is based on another unproven assumption: that if a parent is punished by loss of benefits, a third party will step forward to take charge of the child's benefit, which averages $74.

City and county social service agencies are under orders to develop just such a framework to deal with parents who give birth after going on welfare. An April 1 ruling says that anyone then on welfare who has a baby 10 months later would not get additional money for that child, but a third party could spend the money for the child.

Though nothing in the law requires that the third party be a church, that is where the agencies have been looking for help.

"The expectation is there will be 3,000 babies a year," said Lynda Meade, director of social concerns for Catholic Charities. "That means 3,000 volunteers a year for this alone."

She said members of the faith community feel that taking on such a role compromises their relationship with people they are trying to help, and also raises serious liability questions.

Who will pay the costs of compiling reports? What happens if a family contends it never received what it was supposed to receive? What if there are arguments over what should be bought?

Martha Young, director of the Central Maryland Ecumenical Council, said many religious leaders feel the state is trying to foist off one of its basic responsibilities.

"Your average church has a pastor, maybe two, a secretary and maybe a paid sexton," she said. "The rest are little old ladies in tennis shoes volunteering. They are supposed to help people who are out of compliance when the state can't get them in compliance.

"To oversee a family and buy for them requires a tremendous amount of work. I'm looking at a little old lady in tennis shoes with $76 to cover an entire month of diapers, clothing and winter coat. What do you do when the money runs out? What church do you know that is willing to shove a mother and child out in the cold?"

Lynda G. Fox, deputy secretary of the Maryland Department of Human Resources, said she had been trying to resolve the liability issue.

"If benefits get lost or misused," she said, "we will be responsible for replacing the benefits." Perhaps other adjustments are needed, she said. "The legislature saw this as the community taking more responsibility for the welfare issue. We need to think this through."

Even if liability issues are solved, finding volunteers is not easy. Maureen Robinson, a county social services spokeswoman, earlier worked with a program that matched volunteers with elderly Social Security recipients who needed help paying bills because of failing eyesight or forgetfulness. Most volunteers wanted to help someone nearby, not halfway across the county or in a neighborhood that made them nervous.

Beyond that, the tone of the debate troubles many who support reforming welfare. "Maryland still seems to be buying into the punitive federal attitude that to be poor is to be punished," said Young. "We can do better."

Pub Date: 12/08/96

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