About 10% of the 35,000 Mainers who have gotten health care coverage since the state expanded Medicaid are receiving treatment for opioid use.
By: Joe Lawlor, Staff Writer
About 10 percent of the 35,000 adults who have gained health care coverage since Maine expanded Medicaid in January are receiving treatment for opioid use disorder.
Health care experts have predicted that Medicaid expansion will result in 70,000 additional Mainers enrolling in the program by the end of 2019. If current trends hold, that would amount to roughly 7,000 additional Medicaid patients getting treatment for opioid use.
Opioid treatment typically consists of medication that curbs cravings – most commonly Suboxone or methadone – combined with therapy.
The system so far seems to be absorbing the increased demand, although experts caution that many problems persist, including low Medicaid reimbursement rates for substance use treatment and lack of access to long-term residential treatment programs.
But experts say getting patients into outpatient Medicaid services has improved with expansion, which started in January when Gov. Janet Mills took office. The expansion has provided health care coverage to low-income, mostly childless adults, most of whom were previously uninsured.
“We are noticing a difference,” said Leslie Clark, executive director of the Portland Community Recovery Center, a nonprofit that offers support services for those struggling with substance use disorder and often refers patients into treatment. The center gets 48,000 visits per year by those in recovery, although many are repeat visitors.
“We are now much more likely to successfully refer patients into outpatient behavioral health treatment,” Clark said.
Through June, 2,741 adults had received opioid treatment out of the total expansion population of 27,176 people, the Maine Department of Health and Human Services reported this week.
Treating the 2,741 patients cost $8.4 million, with 90 percent of that paid by federal government. In the entire Medicaid population for the 2018-19 fiscal year that ended June 30, Medicaid shelled out $48.2 million for opioid treatment for 14,722 Medicaid patients, with two-thirds or more of the tab picked up by the federal government. About 315,000 Mainers are enrolled in Medicaid.
Medicaid expansion enrollment has risen to nearly 35,000 Mainers through Aug. 16, with an estimated 3,500 receiving opioid treatment.
The 10 percent figure is consistent with a 2019 Urban Institute study, which found that states that had expanded Medicaid saw 10 percent of the adult enrollees receive medication-assisted treatment for opioid use in 2017, up from 3 percent in 2013.
Gordon Smith, director of opioid response for the Mills administration, said that 880 doctors and nurse practitioners are Suboxone prescribers, up from about 500 prescribers a few years ago. The federal government requires doctors and nurse practitioners to undergo training before being permitted to prescribe Suboxone.
“The reports in the field that I’m seeing are that waiting lists are dramatically shorter than they once were,” Smith said. “There’s no question that expanding Medicaid coverage helps.”
Smith said methadone reimbursement rates have improved, but Medicaid reimbursement rates for Suboxone treatment are insufficient – about 50 to 60 percent of the cost of the service. Outpatient Suboxone treatment costs about $4,000 to $7,000 per year, per patient.
A proposed 8 percent reimbursement rate increase for Suboxone was shelved in this year’s Maine legislative session, but Smith said the administration is expected to conduct a rate analysis and try again in 2020.
Katie Fullam Harris, senior vice president of government relations for MaineHealth, the parent company of Maine Medical Center, said reimbursement rates need to improve but that, nevertheless, MaineHealth has expanded access to patients. The system has created four substance use treatment “hubs” within the past three years: in Rockland, Biddeford, Springvale and South Portland. The South Portland location opened this summer.
Each hub can serve up to 150 patients per year, Harris said. Once patients receive the therapy they need from addiction specialists, they are referred to the “spokes” – or primary care practices – where doctors can continue prescribing them Suboxone if needed.
Harris said that for the most part MaineHealth has been able to absorb the additional patients without putting people on lengthy waiting lists. She said there were some temporary issues with capacity this summer, but they have been solved with the opening of the South Portland hub and other shifts in personnel to address demand.
Clark said, despite the improvements in outpatient therapy, patients who need residential treatment are still having difficulty finding it. Some patients do not do well in outpatient therapy and need a more controlled living situation.
“Trying to find a higher level of treatment for patients is still nearly impossible,” Clark said.
This article appears in the Portland Press Herald.