Expanded Medicaid Has Increased Access To Opioid Treatment, But Waitlists Have Ballooned

May 1, 2019

When Janet Mills ran for governor, she promised to expand Medicaid to help combat the opioid crisis. Her campaign estimated that 25,000 Mainers couldn’t access treatment for substance use disorder either because of a lack of capacity or a lack of insurance.

Now, four months into expansion, providers say they’re seeing a dramatic increase in access, but many are concerned Maine doesn’t have the capacity to meet the pent up demand.

This is the second story in a two-part series. To read the first part, click here.

Ever since he was a teenager, Jesse Waterhouse has grappled with addiction. Alcohol, heroin, anything that made him feel different, he says, he’d use. He had a brief period of sobriety in his 20s, but says he started using substances again and eventually became homeless.

Jesse Waterhouse (right) and Adam Hershkowitz are both newly covered under Medicaid expansion and are getting treatment at Milestone's Old Orchard Beach residential program.
Credit Patty Wight / Maine Public

Last fall, Waterhouse, who is now 34, entered the detox program at Milestone Recovery in Portland.

“At the time, I had no insurance. No money,” he says.

That meant that once Waterhouse finished detox, which takes up to a week, Waterhouse had no place to go for treatment. He had to wait for a grant-funded bed at Milestone’s residential program in Old Orchard Beach to open up.

“So I waited from October to December, going from detox back to the street, detox, back to the street. For me, where my addiction took me, there was no way I was going to live on the street and be sober. It just wasn’t going to happen,” he says. “It was a vicious, vicious, cycle. I overdosed four times in that amount of time.”

In December, a grant-funded bed became available, and Waterhouse moved in. And then in January, when Medicaid was expanded, Waterhouse got coverage. He was able to switch to a MaineCare bed, the state version of Medicaid.

Having that insurance opened up even more services, like case management and therapy.

“Something I have never done before. And it works on that emotional side that a lot of people don’t consider in addiction,” Waterhouse says.

“The difference between having insurance and not having health insurance is the difference between night and day in terms of options that are available,” says Bob Fowler, executive director at Milestone Recovery.

Fowler says Waterhouse’s experience cycling in and out of detox with no options to sustain his recovery is not unusual. Until recently, 80 percent of Milestone’s detox clients lacked insurance.

“The impact [of expanded Medicaid] has been quite profound in a short amount of time,” he says.

Take Milestone’s residential treatment program in Old Orchard Beach. There are 16 beds: three are grant-funded and the rest are MaineCare.

Before expansion, Fowler says, half of those MaineCare beds were often empty. That’s because the people who needed the service — generally, working-age men — often didn’t qualify for coverage.

But now, four months after expansion, Fowler says the beds are all full.

“I think it’s a testament to the fact there was this undermet need that’s now been addressed,” he says.

But as access has improved, waitlists have expanded. Fowler says the list at Milestone’s Old Orchard Beach program is about 10 people deep.

Malory Shaughnessy, executive director of the Maine Alliance for Addiction and Mental Health Services, says waitlists with other providers underscore the need for more capacity. And to increase capacity, she says, Maine needs to increase its Medicaid reimbursement rates to providers.

“In recent years, some of our capacity has been eroded because rates have not maintained a level that can support the service,” she says.

Reimbursement for some services did get a boost in December, but it was primarily directed at Opioid Health Homes. Shaughnessy says community-based providers who offer Suboxone have been left out, and are losing hundreds of thousands of dollars a year.

“The rates don’t support beefing up the staff to meet the need, because the rates don’t cover the staff. So they have to do this balancing act of what they can afford to lose to provide the service,” she says.

It’s an issue that isn’t lost on Maine’s new director of opioid response, Gordon Smith.

“We do need to find a way to increase that reimbursement,” he says.

Smith says he and other state officials are evaluating ways to accomplish that. And while Smith says it’s too soon to extract hard data on the extent to which Medicaid expansion has increased access to treatment, he says the number of providers with waivers to prescribe Suboxone is climbing, and currently stands at more than 800.

Smith says the Mills administration is working with Maine’s congressional delegation to eliminate the waiver requirement to further increase capacity.

“By the end of the year, I’m confident that we’ll have a system and that we’ll have lots more treatment that’s badly needed,” he says.

It’s treatment that Waterhouse is grateful to finally have through Medicaid expansion. Last year, drug overdose deaths claimed more than one Mainer’s life a day.

“If I were not able to get MaineCare, I can almost guarantee I would be one of those statistics. I don’t think I would be here. I proved that to myself out there four times already,” he says.

Originally published April 30, 2019 at 4:47 p.m. ET.