State Medicaid rate change causes concern uncertainty, puts addiction treatment in limboBy RYAN LESSARD
Union Leader Correspondent
July 08. 2018 10:13PM
SALEM — The owner of the largest private addiction treatment provider in the region says he’s forced to wait on expanding capacity until the state announces new Medicaid rates. And if rates aren’t increased enough, he worries that treatment providers across the state will be forced to downsize.
Eric Spofford, the owner and chief executive officer of Granite Recovery Centers, said his organization provides every level of addiction care available, such as medical detox, residential treatment, extended care, intensive outpatient and regular outpatient services and sober living.
It started in 2008 as an 11-bed sober living home. Today, Spofford has seven facilities across the state with a total of 284 beds and 200 employees. The company’s headquarters are in Salem, and its largest facility is in Effingham.
Spofford has never accepted direct Medicaid benefits from the traditional Medicaid population because the daily rate of $162.60 is “incredibly low,” since the cost to provide services is $275 per day.
“One of the main things that we need is a drastic rate increase that’s sustainable ... that enables programs to expand,” Spofford said.
He has accepted Medicaid in the form of premier access rates, which were available through Blue Cross Blue Shield and Harvard Pilgrim on the federal Healthcare.gov marketplace. With the aid of a state subsidy, those plans paid market rates between $300 and $500 for patients in the expanded Medicaid program.
That program, however, is ending by January 2019. Spofford said treatment providers taking a loss from the traditional Medicaid rates were keeping their books balanced with the subsidized market rates. To keep the status quo, the state Department of Health and Human Services will have to bring its daily rate up to $425, he said.
In June, treatment providers across the state rallied in Concord to express their concern that organizations like the Farnum Center will have to eliminate about 50 beds, for example, if the rates don’t go up to compensate for the loss of the premier access program.
Manchester Fire Chief Dan Goonan and Mayor Joyce Craig warned of negative impacts on the Safe Station program.
“It’s a huge deal,” Spofford said.
He said the entire treatment ecosystem and infrastructure the state has built in the past five years is “at serious risk right now.”
The state said it is working to address these concerns. DHHS Commissioner Jeffrey Meyers said his department is working with their actuary to develop new rates for all services, including substance use disorder, and plans to present their proposed rate changes to Gov. Chris Sununu and the Executive Council later this year.
“Working with providers, we are making some adjustments to contract provisions that we believe will lighten the administrative burden on providers and will hopefully reduce their administrative costs,” Meyers wrote in an email.
Meyers said they will enable providers to work with outside consultants to connect uninsured patients with coverage options, as well as clarify staffing ratio requirements between licensed and unlicensed staff and reduce the frequency of required counselor supervision.
The department is also looking into potential uses of federal Substance Abuse and Mental Health Services Administration (SAMHSA) grants to support treatment providers.
The problem now is the uncertainty. Spofford said he’s made a conscious decision not to expand service capacity until the specific details of the new rates come to light, despite continued demand for treatment services.
“Providers need answers sooner,” Spofford said in response to Meyers’ statement. “If the rate is not sufficient to cover actual treatment costs, some providers are going to need to shut down beds or re-organize operationally to try and survive. We need time to prepare because the demand for quality treatment is needed now more than ever.”
He said raising the rates, even just to maintain the status quo, is a moral issue, and any backsliding in treatment capacity could have disastrous effects. Investing in treatment will save in other costs down the road, including welfare, Section 8 housing, food stamps, foster care, fire and EMS services and more, he said.
Not only do recovering addicts put less of a drain on society, Spofford said they begin to work and pay taxes again.
And he would know. He was an opioid addict himself for many years.
“I caused a lot of damage in the community with drug use and drug sales,” Spofford said.
Now, he said he’s giving back in the best way he knows how.