A gap in health care coverage that long has left Medicaid recipients in addiction treatment programs vulnerable is being closed.
Motivated by the opioid epidemic, Virginia began reimbursing agencies for providing substance use disorder treatments like inpatient detoxification and medication-assisted opioid treatment to Medicaid recipients April 1.
In the past, Medicaid patients had “community detox and then they would have to go into an outpatient program, and oftentimes, people with long-term addictions would not succeed in their recovery because they needed sort of a step-down, and they didn’t have it,” Damien Cabezas, CEO of Horizon Behavioral Health, said last month as Horizon prepared to double the number of beds in its downtown crisis stabilization and detox programs.
Those beds are the stepping stones individuals need as they fight addiction. More are being opened because of the reimbursements.
“In other states, where those services were provided, you saw a higher rate of successful recovery, so we’re thrilled we’re able to offer this in Virginia. It will save a lot of lives,” Cabezas said.
The money comes from the $16 million Virginia Medicaid Addiction and Recovery Treatment Services (ARTS) benefit allocation and marks the first time providers have been able to get reimbursed by Medicaid for a host of addiction services. It also increases reimbursement rates for some services.
According to Karen Kimsey, deputy director of complex care services at Virginia’s Department of Medical Assistance Services, which administers the benefits through Medicaid and the Family Access to Medical Insurance Security (FAMIS), the benefit was funded in the 2016 Appropriations Act because of the opioid epidemic and the number of Medicaid recipients without access to the services.
“There’s a desperate need for these services to support individuals in our community,” Kimsey said.
According to a January 2016 policy brief for the state Senate prepared by Virginia Commonwealth University, at least 40,000 adults in the commonwealth’s Medicaid program have a substance abuse disorder.
Eight million dollars now will be used from Virginia’s general fund annually to support the effort. For every 50 cents the state spends, the federal government will match it, Kimsey said.
“We are very excited about it,” Kimsey said, adding the state already has attracted “robust provider participation.”
Medicaid participants now have coverage for in-patient hospital detoxification for 15 days, community-based residential detoxification for another 15 days, residential substance abuse treatment for an average of 30 days, out-patient programs and more.
Horizon, one of about 40 community service boards in Virginia, provides mental health and developmental services to Lynchburg and the counties of Amherst, Appomattox, Bedford and Campbell. As one of the 14 agencies approved to participate in ARTS in the Lynchburg area, Horizon hopes to be the one locals turn to for care. Cabezas said the new reimbursement will cover the cost of services “for the most part.”
The Lynchburg Comprehensive Treatment Center, a private company that provides medication assisted treatment (MAT) to individuals trying to break their addiction to opioids, aims to begin accepting Medicaid patients by June 1.
David Cassise, clinic director of Lynchburg Comprehensive Treatment Center, said in an email last month while demand at his Lynchburg clinic has remained constant since its March 2015 opening, the biggest problem is not the need for MAT services but “the fact that individuals needing those services are not aware of what is out there.”
“Medicaid will certainly help those that are already aware but can’t afford it,” Cassise said. The Lynchburg Comprehensive Treatment Center serves about 300 patients annually with methadone, Subutex, Vivitrol or Suboxone, which treat individuals with opioid use disorder.
After closing its Suboxone clinic in 2016 due to a lack of funding, Horizon reopened it in March to four clients as an outpatient service with a waivered physician specifically licensed to provide the treatment, according to a spokesperson. Horizon is in the process of getting a license from the state to offer MAT under ARTS.
Cabezas said Horizon hopes to be able to provide MAT to 20 clients in May and is looking for a full-time physician to support the expansion.
Another a medication-assisted treatment program in Lynchburg, Addiction Allies, LLC, will work with ARTS benefits to help Medicaid recipients overcome substance use disorders. It has formed a partnership with the Madeline Centre, LLC a behavioral health treatment provider in Lynchburg and Danville. According to its website, Addiction Allies prescribes medications such as Suboxone and Vivitrol for opiate addiction.
In an email, Dr. Christopher von Elten said Addiction Allies will offer physician assessment and medication treatment, individual and group counseling, case management and an Intensive Outpatient Treatment (IOP) program.
“Outpatient treatment with medication increases success rates and is the most cost effective treatment available,” von Elten said.
This massive increase in access is in response to the opioid epidemic, which claimed the lives of more than 1,000 Virginians in 2016, according to the Virginia Medical Examiner’s Office. Virginia saw just 515 fatal opioid overdoses in 2007.
After seeing the number of fatal drug overdoses in Virginia increase by 35 percent in the first half of 2016, Virginia Gov. Terry McAuliffe declared opioid addiction a “public health emergency.”
This week, Jim Sikkema, chairman of Horizon’s board of directors, said, “I think that given the real challenges that not just Virginia but the entire country is facing with a broad array of alcohol and drug abuse, with the opioid crisis in Virginia, this is what started waking people up; the problem has already been there.
“The opioid crisis in Virginia is really what caused the current action,” he said.
Over the past nine years, Southwest Virginia has been hit hardest.
The opioid overdose death rate from 2007 to 2016 in Russell and Tazewell counties now stands at 25 percent and is even higher in Wise and Dickenson counties, at 26 percent and 38 percent, respectively.
Cabezas said Northern Virginia and Richmond also have seen significant losses.
“Here in Central Virginia, we’ve been fortunate,” Cabezas said. “We have not seen those alarming increases, but we are seeing increases in Bedford, Amherst, [and] Campbell with significant increases in Appomattox, [it is] not to the extent that we are seeing in other parts of the state but enough that [it] is concerning us,” Cabezas said.
According to the state medical examiner’s office, in the past five years there have been six fatal opioid overdoses in Amherst County, six in Appomattox County, 23 in the town and county of Bedford, 19 in Campbell County, 22 in Lynchburg and seven in Nelson County.
All those numbers could climb, though, as 60 cases from 2016 remain open at the state medical examiner’s office awaiting additional reports to certify cause and manner of death.
“There’s really [not] a family that hasn’t been touched by this,” Kimsey said.
Sikkema, a licensed clinical social worker, began his career helping those with substance abuse issues.
Funding and residential treatment are essential, he said.
“Residential [treatment] is so critical because it provides the stabilization and the integration for what’s essential [for clients] to maintain sobriety and stay clean,” Sikkema said.
Because there previously was no money for these services, there now is a pent-up demand, he said.
He calls the funding “heartening” and said Horizon can expand based on demand.
“It’s finally happening in Virginia,” he said.
Horizon’s crisis stabilization unit served 595 patients, and its detoxification unit served 470 patients from January 2016 to December 2016, according to Cabezas.
He said Horizon has seen a 10 percent increase in patients in each of those programs every year for the past three years.
In anticipation of more growth because of ARTS funds, Horizon separated its detox and crisis stabilization units onto separate floors at the Horizon Wellness Center at Court Street facility and expanded each. The detox unit now can accommodate 16 patients, up from six, and the crisis stabilization unit now has 16 beds, up from 10.
Horizon also is hiring 25 additional staff.
“There’s a huge job creation in terms of this,” Cabezas said.
Horizon also plans to open the doors of its six-person recovery residence for women with co-occurring mental health and substance abuse issues on Denver Avenue in Lynchburg on May 1. The residential treatment house, which will cost about $150,000 annually to operate, was supposed to open in December 2015 and be funded by the agency’s nonprofit and state money. It never opened because of a lack of funding, according to Cabezas.
Previously, Medicaid didn’t provide a reimbursement for recovery residences like the Denver Avenue house.
As providers and patients begin making use of the ARTS benefits, Kimsey said the state will be monitoring health outcomes closely to demonstrate the value of the benefits.
“We anticipate seeing an improvement in their health outcomes,” Kimsey said, explaining DMAS expects the funding to translate into better access to health care, fewer emergency department visits, fewer hospitalizations, reduction in overdoses, and coordinated health care for Medicaid recipients.
DMAS has a contract with VCU to evaluate access to care, outcomes, program expenditures and determine if the benefits help decrease patient’s overall health care costs. It will provide a report to the legislature once there are measureable results.
“Which still leaves us the problem of the uninsured,” Cabezas said.
According to the 2015 American Community Survey released in September of 2016, approximately 746,000 Virginians remain uninsured, down from 1 million in 2010.
Cabezas said about 300,000 uninsured Virginians have mental health or substance abuse issues.