Columbia County opioid program still in limbo
Columbia County will continue to have a medication-assisted treatment program for at least another year.
But the operation method of the program, for people battling addiction to opium-based drugs, is up in the air because the County Board’s Finance Committee opted to wait at least another month before deciding whether the program should be operated in-house.
No one disputes the need for the program, said Committee Chairman Dan Drew of the town of Pacific.
“This is a serious crisis in our county, our state and our country,” Drew said. “But when I think about sustainability, I have to think about it from the financial perspective.”
Health and Human Services Director Dawn Woodard reiterated the same proposal she brought to the Finance Committee in June: Use the $350,000 state grant that the county will have for the program (effective from Aug. 1 until the end of July next year) to hire three limited-term social workers, to operate the program in Columbia County rather than contracting with an outside agency.
The county had been contracting with Tellurian, a Madison-based substance abuse agency, to operate the program.
But Program Coordinator Stacy Davenport said the arrangement with Tellurian had to be terminated because the agency could not hire enough qualified people to meet the program’s requirements.
The approximately 50 clients served by the program are working with HHS staff now. But the workload is challenging, Davenport said.
Tellurian’s workers had the background in substance abuse treatment, Davenport said, but not in social work and case management. If social workers employed by Columbia County operate the program, then the county can provide direct oversight for the program, and the social workers can work more closely with related county programs, such as Comprehensive Case Management for people with mental health issues, or the new Drug Court, she said.
According to Davenport, HHS officials have sought other agencies to contract with the county for the medication assisted treatment program, and the only one that expressed interest quoted a price of $532,000 for three full-time social workers.
Woodard said the $350,000 grant should cover the full cost of the program if it can be operated in-house.
Furthermore, Woodard said, the county can bill the state’s Medicaid program for at least some of the costs of services to the program’s clients, once their addiction crisis is addressed and they become eligible for Comprehensive Case Management.
But billing Medicaid isn’t all that easy, said Cathy Karls, who oversees Health and Human Services accounting.
Each case is extremely complicated, she said, and Medicaid’s maximum reimbursement doesn’t always cover the actual cost the county incurs. As a result, the existing accounting staff cannot handle the billing if the number of cases keeps growing.
Committee member Barry Pufahl of Pardeeville said his main concern with using the grant money to hire county employees is the possibility that, if the grant money dries up, the county will either have to dip into its own coffers to keep the employees or dismiss them.
Nevertheless, it was Pufahl who moved to go ahead with operating the program in-house with limited-term social workers. The motion died for lack of a second.
Committee member Matt Rohrbeck of Portage said there is, as of now, no perfect solution to the issue, whether that issue is defined in terms of method of operation or financial sustainability.
Drew said the committee simply needs more time and information before making a decision.
Supervisor Nancy Long of Lodi, a member of the Health and Human Services Board, responded, “With all due respect, we still have those 50 cases. Something has to be done now.”
After the committee voted to table the matter, Woodard said the county can still accept the $350,000 grant and keep the program going.
But until the end of 2018, she said, either existing staff or an outside contractor would have to shoulder the task. There’s a possibility that county officials could reconsider the matter later this year, in time to inaugurate in-house operation with three new social workers at the beginning of 2019, she said.