Health law could overwhelm addiction services
MIAMI - More than 230,000 Floridians would be newly eligible for substance abuse treatment under the federal health overhaul and that number nearly doubles if the state also expands Medicaid, according to research by The Associated Press. While experts are encouraged by the increased access to services, some worry the demand will burden an already strapped industry. “There's going to be a period of stress but in no way does it deter us from fully supporting the full expansion,” said Bob Sharpe, president of the Florida Council for Community Mental Health. Currently only 1 cent of every health care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. Many experts say one of the biggest barriers has been a lack of health insurance, but that will change under the Affordable Care Act and more Floridians will likely get coverage through some type of alternative to Medicaid expansion and tens of thousands may be eligible for federal subsidies to purchase their own private insurance through the state's online health exchange in less than a year. More than 1.3 million Floridians, or 9 percent of the state population, need substance abuse treatment, although only about 112,000 are actually receiving that help. But 231,392 Floridians could get treatment under the federal health law and more than 408,000 could get treatment if the state opts for some type of Medicaid expansion, according to an AP analysis of government data.Florida lawmakers are still deciding how they will implement the federal health law. Legislators have shot down any plans that would expand straight Medicaid coverage, but a proposal is gaining traction in the Senate that would use tens of billions of federal dollars to give roughly 1.1 million residents vouchers to purchase private insurance. However, Republican House leaders have been adamant about not accepting funds tied to the Affordable Care Act and have proposed a less ambitious plan that would cover about 115,000 residents using state money. That uncertainty has made it difficult for substance abuse and mental health officials to take action and make decisions about issues like how many new beds they might need. Roughly 95 percent of the 7,000 beds at Florida substance abuse facilities are occupied, according to AP's research. Instead, substance abuse facilities are still mostly in the planning phase, said Sharpe. “They're not out there hiring new professionals, they don't have new sites being developed but they know it's a real problem if these things come to pass,” he said. Part of their efforts will include ramping up recruitment for workers, including going after professionals who have moved into other industries and retaining workers who are contemplating retirement. The industry has a high turnover rate and struggles to pay competitive salaries, but Sharpe said he hoped the new health law and funding streams will allow agencies to adjust salaries so they can retain more experienced staff. “In Florida, we've had sort of a rolling crisis for years in terms of uninsured folks with substance abuse issues or mental health treatment. There really isn't sufficient money in the system to treat folks as comprehensively as would be helpful,” said Jay Reeve, the CEO of the Apalachee Center in Tallahassee, which provides substance abuse and mental health treatment to about 6,000 people a year in eight counties, including many rural areas. Regardless of what path the state chooses to use in implementing the Affordable Care Act, Reeve says it will only help the system. He doesn't predict an influx of new patients in the system, arguing that the state is already treating many of them through various community and welfare programs. Experts say the new system will to push addiction treatment from being marginal part of the health care system out of church basements and into the mainstream of medical care. Reeve hopes for a dramatic change in the type of treatment paid for by Medicaid or private insurers, which he said both only cover “a fairly narrow range of services.” It has been six decades since doctors concluded that addiction was a disease that could be treated, but today the condition still dwells on the fringes of the medical community. Professionals say they welcome the chance to treat more individuals, but worry the Medicaid and private insurers haven't caught up with science of addiction and often aren't willing to pay comprehensive services “One of the great challenges that I think Florida faces with this is that we've always had some trouble as a state taking addiction seriously as medical illness,” said Reeve. Addiction, like mental illness, requires so-called “wrap-around services” that don't just treat the addiction, but deal with a host of other issues that may include everything from psychiatric care to education and job training. But if insurers don't expand the services they are willing to pay for, experts worry some addicts will only get bare bone services or none at all. “Otherwise a whole lot of folks receiving substance abuse treatment now are just going to fall through the cracks,” said Reeve. “If they don't fit into the right pool there's not going to be any more money to treat them unless we don't start recognizing that we're talking about a serious medical illness here.