Medicaid expanding to cover inpatient, residential addiction treatment

By: Mary Shinn

September 30, 2019

Originally appeared in The Durango Herald

20 La Plata County deaths this year involved drugs or alcohol

An expected Medicaid expansion next year will allow more low-income Southwest Colorado residents struggling with drug and alcohol addiction to seek more intensive treatment.

Local addiction experts say they hope new access to inpatient and residential addiction treatment can help prevent overdose deaths, which have been rising statewide for decades.

The number of Southwest Colorado residents who need intensive care is likely small, but it could give some patients with severe substance problems an important new option, said Stephanie Allred, Axis Health System senior clinical director.

“We just see them struggle in outpatient care and get disheartened,” Allred said.

Across the state of Colorado, the number of people dying by overdose has been rising since 2000 when 351 residents died by overdose, according to the Colorado Department of Public Health and Environment.

In 2018, 974 residents died by overdose, a decline from 2017, when 1,012 people died by a drug overdose, the agency said.

In La Plata County, nine residents died by overdose in 2018, and so far this year, five people have died by overdose, according to data kept by the La Plata County Coroner’s Office. This year, drugs and alcohol have been involved in 20 La Plata County deaths, including suicides, homicides and accidental overdoses, data show.

The new Medicaid coverage could start in July if the state receives approval from the Centers for Medicare and Medicaid Services, said Marc Williams, a spokesman with the Department of Health Care Policy and Financing.

Axis Health System provides integrated physical and behavioral heath care to the region, but it does not expect to add residential or inpatient treatment services, Allred said. She also doesn’t think the region could support such a treatment center because it would need a high volume of patients to support it.

But Axis Health System does expect to refer patients to more intensive treatment outside the area to help them break their cycle of addiction, she said.

She likened severe addiction to having a neon sign in front of your face constantly encouraging you to use alcohol or drugs.

Outpatient care can help patients set the neon reminder aside, but it remains visible to them, particularly if the patients are socializing with others who are using drugs, she said.

However, limited inpatient and residential care across Colorado could be problematic for the newly insured Medicaid patients, said Lauren Snyder, state policy director with Mental Health Colorado, a nonprofit advocacy group.

“The state is going to have to plan to increase access,” she said.

She said she would expect to see additional care provided to one of the larger towns on the Western Slope, such as Grand Junction.

The Colorado Legislature also set aside $5 million this spring to cover start-up costs of facilities interested in expanding in rural areas, Snyder said.

While the state is filling a gap in insurance coverage for some of its poorest, Allred said many privately insured residents do not have access to residential or inpatient addiction treatment either.

State law requires insurance companies to provide coverage for mental and behavioral health care equal to the coverage provided for physical care, she said. But those laws haven’t been well enforced, she said.

Candice Seay, chapter lead for Young People in Recovery Durango, said she also sees a need for more sober living homes to help residents in recovery stay clean after returning home from treatment.

“Faced with the regular everyday pressures of that life, that’s where the real hard work starts,” Seay said.