Substance Abuse Treatment Agencies Across New Jersey Brace for an Influx of Patients as Medicaid Expansion Looms

About 100,000 New Jersey residents with little or no health insurance are poised to become eligible for Medicaid, and providers of drug and alcohol abuse treatment services are bracing for a flood of patients that may exceed the current capacities of the nation’s mental health and addiction clinics.

Agencies are putting new programs in place for addicts and trying to create more bed space ahead of the expansion of Medicaid that is coming in January thanks to the federal Affordable Care Act – President Barack Obama’s overhaul of U.S. health care. Richard Wohl, an executive at Princeton Healthcare System’s behavioral health program, said he has seen a sea of change in the industry.

“If you look at what’s happening currently, there has been an explosion of outpatient services dealing with addiction within the past year,” Wohl said. “These places are positioning themselves to be ready when this influx of patients begins.”

About a quarter of the state residents who will become eligible for low-cost coverage under Medicaid are likely to require treatment, and the influx of new patients could overwhelm New Jersey’s already-packed substance abuse recovery facilities, said Debra Wentz, CEO of the New Jersey Association of Mental Health and Addiction Agencies.

The state has been meeting with treatment centers to discuss “capacity, expectations, programming and a myriad of other treatment issues” ahead of the influx, Department of Human Services spokeswoman Ellen Lovejoy said. “The state is working with addictions prevention and treatment providers to prepare for an expanded need for services.”

Competition for Beds

More than 20,000 residents received outpatient substance abuse treatment in 2011, according to DHS data. Overall, 74,014 residents received treatment for alcohol or drug problems that year. Of those patients, 21 percent were insured by Medicaid, which does not cover treatment beyond detoxification.

If New Jersey follows projected national trends, the number of patients seeking treatment could double next year, an Associated Press analysis of government data found.

That means more people vying for spots at inpatient facilities such as the 110-bed Princeton House, which Wohl said is “generally quite full most of the time.” It also means more patients looking to enroll at outpatient facilities, which Wentz said are also overtaxed.

“New Jersey’s community-based behavioral health-care system is overwhelmed with individuals in need, who endure long waits for many types of services, particularly outpatient care,” Wentz said. “Many people go to emergency rooms, seeking help when they experience behavioral health crises, and the capacity for serving them in these venues is very limited as well.”

Trenton ranked third worst in the state for high rates of avoidable hospitalizations, a Rutgers University study found earlier this year.

Many of the avoidable hospitalizations came from untreated alcoholics and drug users seeking medical help, said Dr. Ruth Perry, executive director of the Trenton Health Team, an organization created by the city and area health-care providers to improve delivery of care.

The Trenton Health Team received a $5.2 million state grant last month to expand outpatient addiction treatment services at the city’s Henry J. Austin clinics.

Pushing Outpatient Care

Wentz said she believes this is part of a statewide trend in behavioral health. The DHS now pushes addicts toward outpatient treatment centers rather than inpatient facilities, Wentz said.

“The state is increasing its focus on having individuals receive behavioral health-care services in the community, rather than institutions,” Wentz said. “This is a positive direction, since community-based services are highly effective and much less expensive than institutional care.”

“However, capacity in the community-based system must be increased significantly,” she said.

If outpatient facilities increase capacity to meet demand, the Medicaid reforms have the potential to make a tremendous impact on addiction treatment in New Jersey, Wentz said.

“This is undoubtedly a big deal for the state, especially considering the already large and increasing number of people in need of addiction treatment services,” Wentz said. “It is a tremendous step for moving addiction treatment, as well as mental health care, into the mainstream.”

Across the country, the new demand could swamp the system before even half of the newly insured show up at the door, causing waiting lists of months or longer, treatment agencies say. In recent years, many rehab centers have been shrinking rather than growing because of government budget cuts for patients who receive public support.

“Advocates just get so excited, but at some point, reality is going to hit and they’ll find it’s not all it was cracked up to be,” said Josh Archambault of the Pioneer Institute, a nonpartisan public policy research center in Boston.

In the coming years, treatment programs and medical colleges will face pressure to ramp up to create a larger system. But until then, addiction treatment may represent an extreme example of one of the Affordable Care Act’s challenges: actually delivering the care that people are supposed to receive.

Many with substance problems are waiting eagerly for January, when the new insurance will become available.

“It’s the chance to clean up and not use anymore, so I could live a stable life,” said 30-year-old Ashley Lore of Portsmouth, Ohio, who was jailed and lost custody of her 4-year-old daughter as a result of her heroin addiction. “If I get into treatment, I get visitation to my daughter back. And I get her back after I complete treatment.”

A Lack of Coverage

Only about 10 percent of the 23 million Americans with alcohol or drug problems now receive treatment, according to the National Survey on Drug Use and Health. Shame and stigma are part of the reason, but about a quarter of them also don’t have insurance coverage. That compares with the overall uninsured rate of 16 percent.

With money for treatment limited, slots in rehabilitation centers and hospitals are scarce. In Minnesota, which has one of the higher substance abuse rates in the nation – 11.6 percent of the population – there are slightly more than 3,900 inpatient beds for the 491,000 people who need treatment, according to federal data.

Insurance can mean the difference between getting a spot or waiting indefinitely for publicly subsidized help.

Michelle Hines, an Illinois mother, had both experiences when her 19-year-old son became part of a disturbing new trend: suburban teenagers hooked on heroin.

Because he was uninsured, the wait would stretch to a month or six weeks for a public bed. His parents, who own a small business, couldn’t afford the $2,000-per-month injections to block the heroin high. Overall, outpatient programs cost about $10,000, and a residential treatment stay about $28,000.

Everything changed after her son was able to get coverage under the family’s insurance plan because of an early benefit of the Affordable Care Act.

They now pay only $40 a month for the shot that helps him stay clean.

“He’s working hard at getting his life back together,” Hines said. “He’s in school full time; he’s got a job.” (Michelle Hines asked that her son’s name be withheld to avoid hurting his future employment prospects.)

Perhaps as important as the expansion, the new law designates addiction treatment as an “essential health benefit” for most commercial plans.

“This is probably the most profound change we’ve had in drug policy ever,” said Michael Botticelli, deputy director of the Office of National Drug Control Policy. “We know one of the most significant reasons for the treatment gap is folks who don’t have insurance or who have an inadequate coverage package for substance use disorders.”

In Illinois, where 92,000 people get treatment now, nearly 235,000 addicts and alcoholics without insurance will be able to get coverage next year. Not only are beds lacking. The pool of physicians who are addiction specialists must grow by 3,000 nationwide, almost double what it is now, to handle the demand, according to health industry experts.

“The big question for providers is how do we bridge the gap between now and then?” said Bruce Angleman of Heritage Behavioral Health Center, which provides treatment in Decatur, in central Illinois.

The Associated Press contributed to this report.

About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. Support for the Trenton Health Team was provided in part by a grant from The Nicholson Foundation. For more information, visit www.trentonhealthteam.org.