Maryland set aside $9.4 million over the past two years to provide drug treatment for welfare recipients and new mothers, but only a fraction of the money has been spent for that purpose, records show.
Less than 15 percent of the money -- $1.3 million -- has been used for drug treatment. Most of the rest has paid for job training, foster care and other social service programs.
Maryland Department of Human Resources officials say it has been harder than expected to find people in the two targeted groups willing to enter treatment. But advocates say the agency's failure is inexcusable.
"This is a tremendous opportunity that's being squandered, and it's being squandered basically because of bureaucratic bungling," said J. Peter Sabonis, director of the Family Investment Program Legal Clinic, which provides legal and other services to the poor.
Sabonis said the basic problem is that the state's system for screening people for substance abuse doesn't work, which means thousands who need treatment do not get it.
The failure to use the money as intended also drew the ire of an influential legislator, Sen. Barbara A. Hoffman, the Baltimore Democrat who sponsored the bill creating one of the two programs involved.
"We've lost two years of potential here," Hoffman said. "It's totally unacceptable."
Human Resources Secretary Lynda G. Fox acknowledged shortcomings in her agency's implementation of the programs, but said efforts to reach drug addicts pose complicated problems. "That money did not go unspent for lack of trying to get it spent," she said.
She does not disagree, however, that her agency should be able to use the money for treatment.
Fox said it was difficult to get the programs going because of the need to coordinate efforts between her agency and the state health department, hospitals and privately run managed care organizations.
"These issues are incredibly complex," Fox said. "The more experience we have, the more able we are to make changes to make the programs more effective."
Hospital policies vary
One of the two programs was the result of legislation Hoffman sponsored in 1997 that targets mothers who give birth to babies with drugs in their systems. It aims to get the mothers into treatment before they go back to the community.
If they refuse or fail to complete treatment, their infants are supposed to be placed with relatives or in foster care, and parental rights can be terminated. The program was established as a pilot in Baltimore City and six Maryland counties.
Fox's department counted on hospitals to identify mothers needing treatment, but she said hospital policies varied. Some tested all newborns for drug exposure and others tested only if the mother or infant was in distress during delivery.
"It's difficult to identify drug-exposed infants, and it's difficult to get the mothers into treatment," Fox said. "Some of those mothers go AWOL, or they enter treatment and quickly drop it."
Another Human Resources administrator, Linda E. Mouzon, said one big problem has been getting to the mothers during their brief hospital stays so they can be placed into drug treatment programs.
Once they leave the hospital, it is harder to get them into treatment, she said. "We picked one of the most difficult groups to deal with," Mouzon said. "They are probably more hard-core in their addictions."
Although $1.7 million was budgeted for the first fiscal year of the program, ending June 30, 1998, none of it was spent. The first year was spent developing the program and working out protocols with hospitals to share information, Mouzon said.
The next year, another $1.7 million was budgeted. Only $83,637 of that was spent on drug treatment because efforts to identify mothers and move them into treatment proved ineffective, she said.
Mouzon said hospitals have been doing a better job in recent months identifying mothers who need treatment, and state substance abuse counselors will be dispatched to work with them before they are discharged.
More screening problems
Fox acknowledged there have been problems with the program for welfare recipients as well.
The state budgeted $3 million in each of the past two fiscal years to cover inpatient costs and other expenses for welfare recipients. But only $374,000 was spent on drug treatment the first year and $843,671 the second, records show.
Again, the main problem was with screening, Fox said.
When a client applies for welfare benefits, a caseworker asks four questions designed to determine if the person might be a drug addict. If so, they are offered treatment.
But few people responded in ways indicating they might have a drug problem, Fox said.
Her agency had thought those who slipped through the initial screening would be identified when they were assigned to the managed care organizations that run the state's Medicaid program.
But that didn't happen either, Fox said.
The managed care organizations, which are overseen by the health department, are involved because they are responsible for providing outpatient drug treatment. They also make referrals for more expensive inpatient treatment, which is funded by the drug program for welfare recipients.
Doctors avoid role
Fox said her department got little feedback from the managed care organizations on their screening efforts. The managed care organizations lacked the information because they were not hearing back from the doctors who see Medicaid clients, she said.
"There's a real cultural issue involved in that the primary care physicians do not believe that it is part of their role to report to a public agency whether someone is addicted," Fox said.
There also have been questions raised about the extent to which the managed care organizations are screening Medicaid clients for substance abuse. In August, a report on their performance found little evidence such screening was being done.
"It's an ongoing issue we're trying to get resolved," Mouzon said.
Specialists improve rate
Fox said that addiction specialists have been moved into selected welfare offices to help identify more recipients in need of treatment as they apply for benefits or renew applications.
That effort, which started in May, has doubled the number of people referred for treatment from about 5 percent to about 10 percent of those seeking benefits, Fox said.
Still, Hoffman said she is disappointed and frustrated by the Department of Human Resources' slow response.
"Look around at what the causes of social ills are, and drugs are the root of this," she said. "You can't be productive workers, parents, people if you are addicted to drugs."