HELENA — Some 10,344 alcoholics and drug addicts in Montana will become eligible for substance-abuse treatment coverage next year under the federal health care overhaul, a number that could jump to 21,473 if the state Legislature expands Medicaid to the working poor.
That potential increase, based on an Associated Press analysis of U.S. government data, could mean a strain on Montana’s public and private treatment facilities, which are now operating over capacity in providing care for about 12,000 addicts.
But there are factors outside the numbers that mitigate the potential increases and likely mean there won’t be a sudden rush on rehab facilities, hospitals and mental-health centers, substance-abuse treatment providers said.
That’s because there is some overlap, with many uninsured alcoholics and addicts slated to become eligible for coverage already receiving treatment through programs subsidized by state and federal taxes and grants.
Plus, it takes time to get the word out to those who are newly eligible for services, meaning any increased demand should be gradual, treatment providers said.
Also, officials are hopeful that an expansion of the Medicaid rolls would mean more funding for new treatment services and centers in communities across the state.
“There is a need for treatment services now we can’t meet because there’s no way to fund them,” said Peg Shea, a Missoula-based substance-abuse treatment consultant. “Our money hasn’t grown much to provide more levels of care.”
Only about 12 percent of the 96,000 people in Montana who need treatment for substance abuse are getting it, according to 2011 statistics from the Substance Abuse and Mental Health Services Administration.
Richard Opper, director of the state Department of Public Health and Human Services, said 1,152 people now receiving substance-abuse treatment are covered by Medicaid.
Things will begin to change next year. The health-insurance exchanges coming online in each state as part of the federal Affordable Care Act mean 10,344 more alcoholics and addicts in Montana will become eligible for insurance in 2014 — even without expanding the Medicaid rolls, according to the substance abuse administration’s National Survey on Drug Use and Health.
If the Legislature expands Medicaid, that number becomes 21,473, according to the federal agency.
A bill before state lawmakers would expand Medicaid coverage to up to 70,000 people who earn less than 138 percent of the poverty level, about $15,000 for a single person. But time is running out in the legislative session.
The state has not conducted a specific assessment of the effects of Medicaid expansion on substance-abuse treatment programs, Opper said.
Montana’s treatment facilities are already running above capacity. There is a four-to-six-week waiting period at the 50-bed, state-funded Montana Chemical Dependency Center in Butte.
Medicaid expansion would enable uninsured people already being treated to pay through the federal health program, but it should not result in a huge influx of new people seeking treatment, said Mike Ruppert, Boyd Andrew Community Services’ CEO and president of the Montana Addiction Services Providers.
“Those people are already getting the services because they’re eligible for funding,” he said.
Boyd Andrew runs a methamphetamine treatment center for female inmates in Boulder and a halfway house for substance abusers, plus provides outpatient treatment for 250 to 300 people.
The great majority of people who seek treatment from Boyd Andrew are uninsured, Ruppert said. They pay what they can, with the remainder paid out of federal block grants totaling $250,000 a year and revenue from the state alcohol tax, which adds another $50,000 a year.
That money has been adequate to cover the demand in Lewis and Clark County, Ruppert said.
Shea, the consultant, said she believes there will be increased demand once coverage expands. After Massachusetts enacted its health care reform, there was an increased demand for substance-abuse treatment in that state, but it took two or three years.
“There wouldn’t be an onslaught, it would take time to build up, to make people aware that they have this opportunity,” Shea said.
Both Ruppert and Shea agreed that Medicaid expansion could result in the additional services, including more inpatient beds.
A best-case scenario is that with more addicts covered by insurance, small treatment programs could open in towns whose residents don’t have any options now but to seek care in larger cities, Shea said.
Treatment closer to home helps families and patients, giving them a better chance to succeed, Shea said.