Critics say Maine slow to expand opioid care for uninsured
By MARINA VILLENEUVE
Feb. 15, 2018
AUGUSTA, Maine (AP) — Five uninsured Mainers benefited last year from a multimillion-dollar plan that was supposed to help combat the opioid crisis by expanding treatment to as many as 400 individuals with or without insurance.
The state Department of Health and Human Services in a Feb. 6 report said it spent $13,000 on five uninsured Mainers in 2017, while it spent about $43,600 on 50 members of MaineCare, the state's Medicaid program. This has prompted criticism that Republican Gov. Paul LePage's administration has been far too slow to roll out the program at a time when one Mainer a day is dying of a drug overdose.
Defending their approach, the department's leaders said they are now working on nine contracts that could serve up to 144 more uninsured individuals, and expect enrollment numbers to keep increasing.
Linking primary care with medication-assisted treatment would allow the state to reach more people, said former Health and Human Services commissioner and Republican gubernatorial candidate Mary Mayhew in press releases announcing the plan last year. Mayhew did not immediately respond to a request for comment on Thursday. Director of MaineCare Services Stefanie Nadeau said the Opioid Health Home model provides "whole-person treatment" for opioid abusers through substance abuse counseling, care coordination, peer support, medical consultation and encouraging medication-assisted treatment.
Last March, lawmakers set aside $3 million in general funds and $1.8 in federal dollars for the plan. Mayhew signed an emergency rule adopting the Opioid Health Home model in April, and the rule was adopted in its final form in July.
The department said Maine now has 18 approved Opioid Health Home sites across the state, including Penobscot Community Health Center, Catholic Charities and Groups Recover Together. Nadeau said the department will continue to consider making changes to the program based on feedback from providers, who have asked to treat more than eight individuals at a time.
But critics say the need for treatment is overwhelming the LePage administration's efforts.
"DHHS has moved cautiously forward implementing opioid homes when we need to be bolder establishing treatment programs that do not have so many barriers for organizations," said Democratic Rep. Patty Hymanson.
Maine Alliance for Addiction and Mental Health Services Executive Director Malory Shaughnessy said requirements for Opioid Health Homes are too restrictive. She said the department should have instead provided more funds for existing contracts for treatment services.
"For new access, we only saw a couple of people without insurance getting access to treatment after a year," Shaughnessy said. "I think that's appalling."
The department's figures show that its model is well-meaning but too expensive for providers, said Mark Publicker, an addiction medicine specialist and former president of the Northern New England Society of Addiction Medicine. He questioned if more expensive care is necessarily superior or needed for every individual with opioid addiction.
"My concern about is that the amount of treatment that's required, and the complexity of the systems to support that treatment, is such that it would limit availability for treatment to people, especially to the uninsured," said Publicker.