Louisiana is in the middle of an opioid crisis, but a pervasive state budget shortfall may lead the state to eliminate some drug and alcohol treatment options for people with Medicaid after July 1.
The latest state budget proposal, passed by the Louisiana House, scraps $47 million worth of state and federal funding that pays for outpatient drug and alcohol treatment programs for adults enrolled in Medicaid. In January, 4,600 people were using services paid for with this money that would no longer be available, according to the Louisiana Department of Health.
It could be worse. The original budget proposal considered by lawmakers completely eliminated drug and alcohol treatment for adults with Medicaid after July 1. It scrapped all inpatient and outpatient substance abuse treatment funding — a total of $74 million from state and federal sources.
House members voted to restore some of those cuts however, including all money that goes toward inpatient treatment programs for adults in the Medicaid program. Some outpatient treatment funding, though not all of it, was also restored.
That larger cut proposed earlier in the process may still be on the table though. The Louisiana Senate hasn’t voted on its version of the state budget yet and there are a lot of competing interests for scarce dollars, particularly when it comes to health care.
Louisiana has a $648 million budget shortfall starting July 1. Substance abuse services are vying for money with group homes for people with intellectual disabilities and hospitals that train medical students. The Senate could decide to take some of the funding the House put toward drug treatment and use it for other purposes.
Gov. John Bel Edwards and the Senate leadership would like the Legislature to meet in another special session — after this session ends — to raise or renew taxes to avoid drastic health care cuts. It’s not clear whether the House will agree to do so, however.
The health care cuts would affect drug treatment centers in the New Orleans area, possibly shuttering them for good. Eighty-five percent of the clients at Odyssey House Louisiana, located in New Orleans, have health insurance through Medicaid. Over 90 percent of people treated at Responsibility House in Jefferson Parish are enrolled in Medicaid. Many of those patients would lose their ability to access drug treatment completely through the proposed cuts.
If Louisiana eliminated funding for inpatient drug treatment in the Medicaid program, Edward Carlson, chief executive officer of Odyssey House, anticipates 60 percent of drug treatment facilities around the state would close. Mike Martyn, executive director of Responsibility House, said his center — which serves about 45 inpatient and outpatient clients — wouldn’t be able to operate anymore. His funding would go from about $2.4 million per year to $200,000 per year.
Odyssey House would survive — but it wouldn’t be able to offer most of the substance abuse services it does now.
Its detox center and residential treatment program would shutter. Carlson said it would only survive to offer other types of services — including HIV/AIDS treatment — that it has federal grants to dispense. The number of people it could treat would drop from from around 900 per month to 340 per month and the facility would have to cut 60 percent of its staff, Carlson said.
Odyssey House has the only drug and alcohol detox center in South Louisiana that doesn’t require private insurance and serves people who are poor, according to Carlson. Hospitals in the area do detox sporadically, but most just try to stabilize drug and alcohol users before releasing them.
If a hospital does have to guide someone through detox — which lasts a few days — it can cost seven or eight times what it would at Odyssey House, Carlson said.
Carlson sees the impact of the opioid crisis on a daily basis at Odyssey House. Seven or eight years ago, only about 20 percent of the treatment facility’s client struggled with a heroin addiction. Typically, those people were longtime users. Now, over 60 percent of Odyssey House’s clients are heroin or opioid users — and most of those people were introduced to street drugs after becoming addicted to prescription medication, he said. They are more likely to be a “soccer mom” or other person not typically associated with street drug use.
Odyssey House’s detox center is necessary and in high demand, Carlson said. People line up early in the morning outside the treatment center hoping that a bed opens up for the service.
Some people even overdose in line, while waiting to get into the detox facility, Carlson said. Odyssey House has had to use naloxone — the overdose reversal drug — to revive people while they wait in line on a detox bed more than once. Staff then calls an ambulance to haul them off to the hospital — where they will be stabilized, released again and typically go back to using drugs.
Carlson said Louisiana already does a poor job of managing the opioid problem because it has no coordinated plan to handle the epidemic. Louisiana needs about three times the number of drug treatment beds that it currently has, but the budget cuts would make what is already a bad situation worse, he said.