Legislature misfired with Medicaid

Seeing more Medicaid clients just means you lose more money,’ Walla Walla County’s health administrator says.

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WALLA WALLA — The perception of what the Affordable Care Act would mean for chemical dependency care in Washington state is meeting reality, and officials say it’s not a pretty picture.

When the state operating budget was adopted last year, lawmakers in Olympia counted on big savings with the federal Affordable Care Act. New Medicaid boundaries would encompass people who had needed state help to pay for substance use treatment, explained Abby Murphy, policy director for the nonprofit Washington State Association of Counties.

“So the budget was cut in the anticipation it would be backfilled by Medicaid, that those patients would make up for a lot of the difference.”

There are certainly more Medicaid patients since health-care reform launched in January, but that federal insurance program pays providers less than the state did — 46 cents instead of 64 cents on each dollar billed for service, officials said.

The change was made startlingly apparent as treatment providers billed for January and February.

“That’s when they realized they were significantly short on money,” Murphy said Friday, adding that Medicaid rates do not cover the actual costs of services.

“We knew this was going to happen,” she said. “We advocated last year that legislators not make those significant cuts. They made them anyway.”

County officials will convene Tuesday in Olympia to meeting with the association.

“I’m sure this will be one of the major issues that we’ll be discussing,” Murphy said.

State lawmakers addressed shortfalls in mental-health services but not for substance abuse specifically. Estimates for keeping detox programs in Washington viable for the next year are about $5 million, she noted.

That number came too late for this year’s budget-writing process. Pleas to the Department of Social and Health Services to find a way to not lose providers have resulted in the same answer — “No. So that’s where we’re at right now. Which feels like nowhere,” Murphy said.

In Walla Walla County, health officials are trying to find a way keep Serenity Point Counseling Services open. The chemical dependency treatment center is the only provider accepting Medicaid patients, said Harvey Crowder, administrator of Walla Walla County Department of Community Health.

“It’s difficult to project what’s going to happen,” he said. “Seeing more Medicaid clients just means you lose more money.”

The county’s money from the mental-health tax cannot legally be used to augment Medicaid rates, even as chemical dependency treatment falls solidly under that banner, he said.

Affordable Care Act officials say costs will eventually even out as people need less emergency department visits as they use health insurance to get regular care. Bigger operations have buffers and can hang on until that happens, Crowder said.

“But the small agencies may not have the reserves and corporate backing when the number of Medicaid clients expands,” he added.

The state must find a way ensure people can get help for addictions, Murphy said.

“Without treatment it’s a bleak future for substance abuse.”

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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Comments

PearlY says...

"Affordable Care Act officials say costs will eventually even out as people need less emergency department visits as they use health insurance to get regular care. Bigger operations have buffers and can hang on until that happens, Crowder said."

There is no meaningful economic data to show that "costs will eventually even out" under ACA, there are only hopes, fantasies and guesses. Bigger operations may survive a little longer as they eat up their "buffers" (their owners' equity) but they will end up in the same place.

Posted 16 March 2014, 1:32 p.m. Suggest removal

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