Q&A with New Futures’ Michele Merritt
Michele Merritt, policy director for New Futures, the statewide organization whose mission it is to prevent and reduce alcohol and other drug problems in New Hampshire, recently visited NH Business Review to provide an update on the opioid crisis which is taking a toll on the state’s workforce.
Merritt, a former hearing officer at the NH Department of Labor, also has worked at the Disabilities Rights Center in Concord.
Q. Why did more than 400 people die in New Hampshire last year because of opioids?
A. We are second to last in treatment access rate. Our traditional Medicaid population didn’t have a substance usage disorder benefit. We didn’t expand Medicaid in New Hampshire until August 2014. With Medicaid expansion, the steady funding stream would allow providers to expand treatment capacity.
Q. What’s happening to the Medicaid expansion bill?
A. The bill has a number of components, like work requirements, so it can get bipartisan support.
Q. Aren’t the people who are receiving expanded Medicaid insurance already working?
A. Half of them are, and legislators want to encourage the other half. They modeled the work requirements after TANF (Temporary Assistance for Needy Families) guidelines – 30 hours per week of paid work or volunteering. There are exemptions. If you were under a course of treatment you can get a provider to say you’re not able to work. It would not be wise to punish a person for obtaining treatment by taking their Medicaid away.
Q. How will the state pay for it?
A. A number of Republicans did not want to have general fund support for the program, but it is bringing upwards of $50 million a year to the state (from federal funding). So they had a discussion with the hospitals and the insurance companies. The hospitals have seen a significant decrease in uncompensated care. As for the insurance companies, the state is paying for the individuals as they shift to a private market-based plan. So both industries agreed to make voluntary contributions based on Medicaid patients that they see.
Q. What do you think of the work requirements?
A. If there is a perception that someone has to do something above and beyond, that could be potentially a barrier to treatment. The current administration has yet to grant any mandated work requirements. Other states tried, and CMS (Centers for Medicare and Medicaid Services) has denied it. New Hampshire is a more innovative approach. We were thoughtful in the exemptions.
Q. So we might be basing this whole thing on something that may not happen?
A. Not exactly. The bill did include a severability clause. If CMS does not approve the requirements, they will be stripped out and the rest of the bill will remain.
Q. But the people backing the work requirements might vote against this.
A. Some say they want to take the severability clause out. There would be no Democrats that would vote for it, so why would you put the whole program at risk?
Q. What was the legislation that emerged from the special legislative session on opioids late last year?
A. SB 576, Senator (Jeb) Bradley’s bill. The penalty for possession of fentanyl has been increased. Possession of fentanyl was a lesser penalty, even though it is 150 more potent then heroin and most of the opioid deaths are from fentanyl. The bill brings those on par with each other.
The bill mandates the use of the prescription drug monitoring program. Doctors have to log in to check someone’s prescription history to see whether or not they have been prescribed opioids. All other states around New Hampshire have that kind of program and share information across borders with each other.
The bill also requires insurance companies to use American Society of Addiction Medicine (ASAM) criteria – national criteria that guides a course of treatment. In order to be credentialed in New Hampshire, providers have to be using ASAM, but insurance carriers under New Hampshire law weren’t required to, so it created this conflict. Insurance companies and providers were fighting over where the person belongs, and in the meantime, the person doesn’t get treatment.
Q. What is going on with the shortage of beds in residential programs and people to staff them?
A. Residential treatment benefits didn’t go into effect until March 1, 2015, and then you had a backlog, so it didn’t start until May 1. It is different from an outpatient program. You need to invest in a building, rehab that building – a lot of a capital investment.
It doesn’t make sense to invest in creating a new facility when we don’t have confidence that that funding sources. They were holding off to see whether or not the health protection program would survive.
Q. What about Affordable Care Act mental health parity requirements?
A. It’s not really happening. Some people are having more difficultly accessing behavioral health services than for general medical services. They are being denied at higher rates.