The recent closure of Arapahoe House, the state’s largest provider of substance use disorder treatment, can be considered the canary in the coal mine. It leaves the state with the urgent challenge of figuring out a funding model that ensures all Coloradans struggling with addiction have access to treatment.
As the provider community picks up the pieces in an uncertain landscape, the opioid crisis has reached epidemic proportions, illuminating how the dangerous misuse of prescription pain killers is as close as our medicine cabinets. This new crisis has further burdened a community of treatment providers already struggling to keep up with perennial drug and alcohol addictions.
For treatment providers that serve as a safety net for lower-income Coloradans, the struggle is acute. Studies show that 90 percent of those who need treatment can’t access it. While some private health plans cover addiction treatment, nearly 1.4 million Coloradans get their coverage through Medicaid, which doesn’t fully cover the cost of quality care. This will continue to leave safety-net providers struggling financially as they try to cover the gap and meet the demand.
High-quality treatment is best served through a continuum of care that includes in-patient residential and outpatient services. In recent years, however, providers have reduced outpatient services due to inadequate Medicaid reimbursement rates. When outpatient services decrease, patients who would otherwise seek treatment often end up in residential treatment, hospital emergency departments or jail — each of which are more expensive.
Meanwhile, the cost of providing treatment for substance use disorder has gone up. A scarcity of certified addiction counselors has driven up salaries and benefits, making it difficult for safety-net providers to compete with private treatment centers that serve patients who have more resources.
Additionally, state regulations on providers who utilize government dollars are administratively costly and burdensome, further increasing their costs. Patient data mandated by the state of Colorado includes an intake process requiring staff to collect answers to more than 100 questions from all patients needing help. This process does not support good clinical care and stigmatizes an already disenfranchised population because of their chronic disease. As a patient going in for any other health care service, you would not be expected to answer this extensive and often intrusive questioning.
Even patients with private insurance can struggle to get access to the coverage they need. When Congress passed the Mental Health Parity and Addiction Equity Act in 2008, it was intended to reduce discrimination and improve access to care for people with mental illness and substance use disorders. While federal and state parity laws both require private health insurance to cover treatment of substance use disorder, families are still struggling to access care. Because of this, providers must hire additional staff to advocate on behalf of patients for coverage of their needed treatment.
The burden of figuring out a funding structure that will adequately support treatment falls to Colorado policy makers and state officials. We are calling for an ongoing conversation among the many state departments that can make a difference in fixing this broken system. The Department of Health Care Policy and Financing, Colorado Department of Human Services’ Office of Behavioral Health, Colorado Department of Public Health and Environment and Colorado Division of Insurance each can play a key role in making Colorado a leader in responding to the drug and alcohol epidemic. Any continued lack of collaboration to find solutions will be harmful not only to treatment providers, but also Colorado individuals and families dealing with the challenges of addiction.
Cheri Jahn represents state Senate District 20 in Jefferson County and serves on the board of directors of Arapahoe House, Inc. Brittany Pettersen represents House District 28 in Jefferson County and serves on the Public Health Care and Human Services Committee.
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