Some health care providers and consumer advocates are optimistic about a plan by the state of Kentucky to expand access to substance use disorder treatment and recovery services amid the state’s opioid crisis.
The expansion, which is tentatively set to begin Monday, is being done through a portion of the state’s Section 1115 Medicaid waiver, also known as Kentucky HEALTH, according to the Kentucky Cabinet for Health and Family Services. Other parts of the waiver, including its much-debated work or “community engagement” requirements, remain on hold due to litigation.
The Cabinet says the waiver will, among other things, expand access to substance-use-disorder providers, allow Medicaid to reimburse for short-term residential stays (up to 30 days) in mental health facilities, and add coverage for methadone, a form of medication-assisted treatment that wasn’t previously covered by Kentucky Medicaid.
It also will allow qualified residential treatment facilities to expand bed capacity beyond 16 beds, elevate program standards, and provide transportation for some people to get methadone treatment, which typically requires daily dosing.
The effort is welcomed by Mental Health America of Kentucky, which is supportive of the Cabinet’s decision to expand the number of treatment beds available and broaden medication coverage, said Executive Director Marcie Timmerman.
“Long wait times, inability to pay and lack of transportation to receive counseling have been considerable barriers,” she said via email. “People with addiction need to enter treatment exactly when they are ready to do so. Delays to getting into care are dangerous. We support these changes to Medicaid and hope to see more elimination of treatment barriers in the months and years to come.”
Dr. Lori Caloia, medical director of the Louisville Metro Department of Public Health and Wellness, said she hopes the effort will spur more providers to offer methadone, a form of medication-assisted treatment that is sometimes stigmatized.
Methadone “lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone,” according to the Substance Abuse and Mental Health Services Administration.
But the MORE Center, which is operated by Public Health & Wellness on South 15th Street, is one of the few local places that offer it.
Right now, “I think it’s difficult to kind of get into the methadone world, just because of the certification and the process to get there,” Caloia said. But the prospect of being reimbursed might make additional providers “willing to jump into that space.”
Medication-assisted treatment — which is sometimes slammed as replacing one addiction for another — is important because it’s evidence-based, helps patients meet their recovery goals and reduces overdose deaths, Caloia said.
“There’s just a lot of benefit to treatment with medication, and we know that the longer people stay in treatment, the better off they do,” she said. But “if finances become an issue a couple of months into treatment and people drop out, then their risk of relapse is going to be even higher than if they’re able to continue in treatment for long-term.”
The MORE Center, which has the capacity to serve 200 people, currently has about 140 patients, and Caloia said she would like to see that number increase. But having to pay $12 a day for methadone treatment has been a barrier since it “adds up pretty quickly for a month of medication,” she said.
Cost also has been a hurdle for pregnant women who receive methadone at the local jail but often can’t afford treatment once they leave Corrections, Caloia said.
“I think this will certainly link those individuals to a mechanism to pay for ongoing treatment,” she said.
In a June 14 news release, Carol Steckel, commissioner of the Department of Medicaid Services, said the state enhancements “will increase and improve services to those fighting with addiction” and impact the quality of life for entire families.
The release indicated that the planned changes are “anticipated” to start July 1.
This week, the Cabinet elaborated by saying in an email, “CHFS/Department for Medicaid Services is ready for a July 1st implementation of the changes to substance use disorder Medicaid services, which include expanded coverage and increased access to care. We are optimistic about the state plan amendment process being approved by CMS (the U.S. Centers for Medicare and Medicaid Services) for a 7/1 start date, and anticipate that the amended regulations will be approved and filed as well.”
When asked to clarify, the Cabinet’s only response was, “The Cabinet does not foresee any obstacles at this moment in time, that would prohibit the changes (referenced in the press release) from going into effect July 1.”
CMS had no immediate reply but said someone would follow up.
Meanwhile, Gloria Berry, marketing director for Centerstone, said the state’s plan has multiple potential advantages for people with substance use disorder. That includes the transportation piece and making it possible for some individuals to stay in treatment longer.
“Sometimes they have to leave too soon and they go back into old patterns,” said Berry, a licensed marriage and family therapist. “It takes a while to create a new habit” and “help them learn how to live sober.”
Centerstone, the former Seven Counties Services, will evaluate its options for making use of the state enhancements, including exploring the idea of offering methadone, Berry said. “We all know here in Kentucky that we have been immensely affected by the opioid crisis.”