One of the selling points for expanding Maine’s Medicaid program was its potential for getting more people who are caught up in the opioid epidemic the help they need. About six months in, it’s clear that some additional steps are necessary.
The expansion of eligibility for Medicaid, or MaineCare as it is known here, was approved at referendum in November 2017 and finally implemented early this year in one of the first acts by Gov. Mills. It was expected to grant health coverage to as many as 70,000 childless adults, many of them square in the demographic groups hit hardest by addiction, allowing them to access drug treatment they could not previously afford.
So far, however, just 26,000 Mainers are covered under Medicaid expansion, according to a report this week from the Associated Press. In some areas where the opioid epidemic has been particularly deadly, signups are low – in Hancock County, less than a third of those eligible have enrolled, the AP reports; the same is true in Cumberland County.
That’s bad news. But given Maine’s history with Medicaid expansion, it’s not a complete surprise. After it passed at the polls, then-Gov. Paul LePage refused to implement it, leaving Gov. Mills to play catch-up. Still, thousands of Mainers now have health care coverage they didn’t before, and with the new data in hand, officials can better focus on the regions where enrollment has underperformed.
The real problem for people with substance use disorder is that once enrolled in MaineCare, they still may not be able to find treatment. While expansion may make treatment affordable, it doesn’t necessarily make it available – and there are still not nearly enough spots available for everyone who needs one.
Why? In his first few years in office, LePage made fewer people eligible for MaineCare and cut already-inadequate reimbursements for drug treatment providers. As a result, treatment providers were left caring for fewer people who had coverage, and that coverage was covering less of the cost of treatment – for many, it was simply an unsustainable business model.
So when the drug epidemic exploded, Maine did not have enough treatment providers, and those who were in place could not afford to take on Medicaid patients, leaving a whole segment of population without anywhere to turn. In fact, from 2013 to 2015, when record numbers of Mainers were dying from drug overdose, treatment admissions actually fell – there was no place for people to go, particularly when it came to medication-assisted treatment such as Suboxone or methadone, which has the highest rates of success.
LePage at the end of his second term increased some reimbursement rates to help his foundering Opioid Health Homes initiative, fixing problems that advocates had pointed out during implementation a year before.
But that was only a narrow fix. More needs to be done. The Mills administration says that other reimbursement rates should be increased, and that it is working with the congressional delegation to loosen laws governing the limits put on Suboxone providers, another bottleneck in the treatment system.
Those changes have to be made sooner rather than later. Medicaid expansion can be a powerful force against addiction. It can help people afford life-saving treatment – but that matters only if the treatment is available.
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