By: Dan Neumann
The number of people who have enrolled in the state’s Medicaid system, MaineCare, which Mainers voted to expand in 2017, reached 40,770 this month.
Within that group, according to the latest tally released by Maine’s Department of Health and Human Services, are 5,752 individuals who are now receiving treatment for substance use disorder who were not prior to Medicaid expansion.
“Expansion is working the way it was intended,” Kathy Kilrain del Rio, a policy analyst at Maine Equal Justice, told Beacon in an email. “Mainers seeking help for substance use are able to get much needed support for recovery and other health care needs, and that’s making a world of difference for individuals and families.”
Last year, MEJ took the LePage administration to court for defying the will of the voters and delaying the implementation of MaineCare expansion, which has made eligible for coverage an estimated 70,000 Mainers within 138 percent of the federal poverty level (an annual income of $35,535 for a family of four).
Under the previous administration, while many states were expanding their Medicaid programs through federal money made available in 2012 through the Affordable Care Act, Maine was actively pushing people off its rolls. In 2014, former Governor Paul LePage cut 14,500 parents and roughly 10,000 childless adults off MaineCare.
“Many of those people had mental health and substance use challenges,” said Malory Shaughnessy, director of the Alliance for Addiction and Mental Health Services. “We’ve seen them cycling through our jails, our prison system, and in and out of our emergency departments over these last few years, spiking the amount of money that we’re paying into those systems for care that’s not the best care for them.”
Those cuts were being implemented as Maine’s opioid crisis really took off. Overdose deaths grew each year of LePage’s two terms as the supply of synthetic opioids spiked. Between 2011 and 2016, MaineCare spending on medications to treat substance use disorder and prevent overdoses was down 21 percent, while Medicaid spending nationally was up 155 percent for those same drugs.
Read the full report on Maine’s overdose deaths by the National Institute on Drug Abuse here.
Healthcare advocates working with uninsured individuals during that time said they were often unable to provide even basic supports to people struggling with addiction.
“I remember getting a lot of calls on our helpline from people who were quite desperate, telling us that without their MaineCare coverage and without the ability to access the treatment they needed, they were terrified — saying things like, ‘I’m going to either end up in jail or dead,’” said Kate Ende, policy director at Maine Consumers for Affordable Health Care. “There wasn’t necessarily a good place to point them. We do our best to connect people with the safety net resources, but in their situation, those basic services were really not sufficient at all.”
But now a slow but steadily growing number of people in Maine can gain access to medication-assisted treatment for their substance use disorder on doctor-prescribed drugs like methadone and buprenorphine.
Long-term treatment in an in-patient setting, advocates say, is much more conducive to recovery than relying on emergency rooms, where people are more likely to be treated for an overdose rather than addiction.
“If you show up in an emergency room, they might give you one dose,” Ende said. “So your problems are going to persist and likely get worse if they are not being managed correctly by a primary care doctor.”
In addition to the new numbers on people receiving treatment for substance use, a Nov. 7 DHHS update reported that Medicaid expansion has allowed an additional 1,527 patients to receive breast cancer screenings, 2,611 have been treated for diabetes, 2,039 for hypertension treatments and 14,360 for mental health.
“You’re looking at half of the expansion being in behavioral health issues — mental health or substance use,” Shaughnessy said, stipulating that there is likely cross-over in those groups. “It just speaks to the critical need to have done this expansion.”
This article originally appeared in The Maine Beacon.