NH needs to step up its commitment to drug treatment

Current low reimbursement rates threaten a dire reduction in service


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Substance misuse treatment providers across New Hampshire are facing an immediate threat to their drug treatment programs and we need state leaders to help resolve this crisis. 

Put simply, what our facilities receive in Medicaid reimbursement from the state, and what we have been receiving for treating patients, is far below what it actually costs for care. Our agencies cannot sustain this shortfall. 

Here are the numbers: The state pays about $162 per patient per day through Medicaid for substance misuse treatment. However, it costs local providers an average of $275 per client per day. We are a collection of nonprofits working with the state to provide care to those who cannot afford it, responding to the worst opioid epidemic we have ever seen. A shortage of basic funds to cover those patients that are sent to us by the state means we face difficult decisions.

We are grateful that Medicaid expansion passed this spring, which ensured rates for reimbursement are established. If that program had been defeated, the funding shortfall would have been immediate and catastrophic. Unfortunately, the rates currently set, along with a change in how the state administers this program, mean providers still face a perilous path.

This is a warning we clearly and repeatedly sounded to lawmakers over the last several months. 

For the past two years, we have been funded through a different system. Under the “Exchange” program, providers were given the same Medicaid rate as now, but the funding gap was filled through insurance companies. Under the newly created system, that difference is no longer filled by managed care organizations, which follow the rates set by the state. We have no way to fill that gap.

Ironically, lawmakers agree with us that Medicaid reimbursements are too low. Last November, a special legislative commission comprised of key legislative leaders recommended action to raise Medicaid rates. Unfortunately, that hasn’t happened.

On July 1, the state had the power to set new, higher rates going forward. They will be able to adjust rates again on Jan. 1. We are urgently requesting that new, higher rates be established.

Providers of all sizes, who represent the entirety of the state’s Medicaid substance misuse treatment, face layoffs and service reduction, having to reduce the number of available beds because we simply cannot afford the cost of care. These decisions will have to be made in January 2019 if nothing changes.

New Hampshire has just 312 residential beds and 31 detox beds, already short of what the state needs. If these rates don’t rise, more than 25 percent of current beds will be eliminated, creating a terrible shortage of available care.

This is the state’s responsibility. A critical component of Senate Bill 313, the bill that reauthorized Medicaid expansion, is a provision that states: 

“In order to combat the opioid and heroin crisis facing New Hampshire, the department shall establish behavioral health rates sufficient to ensure access to, and provide capacity for, all behavioral health services.” 

It’s time to act.

We are anxious to work with lawmakers and department heads to figure out a solution. What we hope will happen is that a commitment to find the estimated $10 million in funds can be made and then the Department of Health and Human Services can set rates higher.

The alternative is a reduction of necessary treatment of this disease of addiction at a time when the state is just starting to make some progress in this fight. Let’s work together. 

Larry Gammon is president and CEO of Easterseals NH, which operates the Farnum Center, a drug treatment facility in Manchester, and Farnum North, a facility in Franklin.

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