For decades, if someone on Medicaid wanted to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources.
Now, in a dramatic shift, the federal government is considering chipping in, too. The agency that governs Medicaid is proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a .
But in Pennsylvania, those who work in the addiction field are not happy with that news. While it鈥檚 a good start, they say, 15 days of residential care isn鈥檛 nearly enough time for many people addicted to heroin, opioids, alcohol or other drugs to get clean and stay that way.
鈥淲here they came up with the 15 days, I don鈥檛 know, but it鈥檚 not based on research,鈥� said聽, head of the nonprofit treatment program Gaudenzia, which serves about 20,000 patients a year in Pennsylvania, Maryland and Delaware. In just 15 days, he said, you can鈥檛 expect to achieve a positive outcome.
鈥淒o you know how expensive that would be, with no outcome?鈥� Harle said. 鈥淲e wouldn鈥檛 want to do it. We would not want to do it.鈥�
Up until now, the state of Pennsylvania has used an obscure provision in the federal law to get federal reimbursement for much longer rehab stays for some people. Pennsylvania officials worry that the loophole will likely go away if the new Medicaid proposal is enacted.
In its , the National Institute on Drug Abuse says:
Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length.
, a professor at Boston University鈥檚 Clinical Addiction research unit, said聽there鈥檚 been little funding for research that gets at the optimal length of an inpatient stay, in terms of effectiveness. And in the absence of good data, private insurance plans are all over the map in terms of how many inpatient days they will cover.
Considering that Medicaid hasn鈥檛 funded residential treatment programs at all, up until now, 15 days is a good start, said聽, a former top administrator at the federal Centers for Medicare and Medicaid Services, which governs Medicaid.
鈥淢aybe it鈥檚 half a loaf for someone who needs 30 days,鈥� said聽Mann, who now works for Manatt Health Solutions, a law and consulting firm. 鈥淏ut it鈥檚 half a loaf of new federal dollars that could be available.鈥�
Chris Benedetto, a 30-year-old who started using heroin when he was 13 years old, in Scranton, Pennsylvania, says he needed much more than 15 or even 30 days in rehab to kick his drug habit.
Chris Benedetto says it took five months of inpatient treatment for his heroin addiction before he was able to finally kick his drug habit of many years 鈥� and stay clean. (Ben Allen/WITF)
鈥淚 was really young,鈥� Benedetto said. 鈥淚 actually was arrested in school.鈥� He bounced from school to probation to jail to rehabilitation. Benedetto said聽he knew how to play the treatment game, fooling his family and others that he was doing well, even when he was still using drugs, or about to slip.
鈥淚鈥檓 good at putting on that mask,鈥� he said.
Eventually, in 2009, Benedetto got into an inpatient facility and stayed there for five months of supportive therapy, thanks to Pennsylvania鈥檚 looser interpretation of federal restrictions. Benedetto said聽the longer rehab stay is what finally enabled him to kick his drug habit.
鈥淔or that amount of time, in that environment, I will show up,鈥� Benedetto said. He鈥檚 now been clean for more than five years and works as an assistant to an addiction counselor.
Samet said聽he likes the idea that Medicaid will start covering at least some inpatient treatment. But he also wants to make sure that doctors and patients consider outpatient programs, which can be highly effective for some people and are less expensive.
鈥淚t鈥檚 the challenge of public policy,鈥� he said. I think this is why the feds go into this kind of work 鈥� because a lot of good can be done.鈥� But, he added, he doesn鈥檛 want residential programs to become the default style of treatment, just because the option is now available.
鈥淭he risk of it being taken advantage of is real,鈥� by both patients and providers, Samet said.
Mann said聽the proposed change still allows state governments to pay for as much treatment as they think a patient needs 鈥� just as they have been doing all along.
鈥淭he state and the locals are completely free to finance that stay if they think it鈥檚 the right place for somebody to be,鈥� she said.
And if they鈥檙e still not happy, she added, states can put together to apply for more federal money.
This story is part of a partnership that includes , and Kaiser Health News.