For decades, people on Medicaid who needed drug or alcohol addiction treatment had to pay for it out of pocket or get help from the state. But in what would be a major shift, the federal government could soon chip in to fund addiction treatment. However, some experts in the addiction field say their proposed contribution is too small to actually help people recover.
The government agency in charge of Medicaid has proposed covering a patient’s first 15 days of inpatient rehab for anyone enrolled in a Medicaid managed care plan. This is a good start, but 15 days isn’t long enough for many people addicted to heroin, opioids, or alcohol to get or stay sober, according Mike Harle, head of the nonprofit treatment program Gaudenzia, which serves about 20,000 patients a year in Pennsylvania, Maryland and Delaware.
“Where they came up with the 15 days, I don’t know, but it’s not based on research” says Harle. “Do you know how expensive that would be, with no outcome? We wouldn’t want to do it. We would not want to do it.”
In Pennsylvania, many patients with addiction have relied on a loophole in the federal law to get federal reimbursement for longer rehab stays. But Pennsylvania officials worry that Medicaid’s proposal might cancel out the loophole, preventing many people from getting the treatment they need.
In its guide to drug addiction treatment, the National Institute on Drug Abuse says there is no recommended exact length of treatment for a rehab stay, since it would depend on the patient’s individual needs. But research has shown across the board that outcomes are much better when a patient stays in treatment for an adequate amount of time.
Many recovering addicts find that 15 days is not nearly enough time. Chris Benedetto, a 30 year old from Scranton, Pennsylvania, who started using heroin at 13, says it took him five months of inpatient treatment before he was finally able to quit his addiction of many years. “For that amount of time, in that environment, I will show up,” says Benedetto, who has been clean for over five years.
Cindy Mann, a former top administrator at the federal agency which governs Medicaid, defended the proposed change. Even with the new federal guidelines, she says state governments will be able to continue paying for as much treatment as they think a patient needs. “The state and the locals are completely free to finance that stay if they think it’s the right place for somebody to be,” she said.
