Idaho’s state health agency has dramatically cut its spending on substance abuse treatment, due to a budget shortfall that took officials by surprise last fall.
The cuts, which could last through the end of June, do not affect people who started treatment before the state ratcheted down its spending. But health care providers say the cuts are keeping many people from getting into treatment now — including IV methamphetamine users, men and women with alcohol addictions, and some Idahoans who need court-ordered treatment but cannot afford it.
Idaho substance abuse providers said the problem affects anywhere from 33 to 80 percent of their prospective clients. The cuts have eliminated the option of inpatient rehab for many Idahoans who need it, providers said. The only path to treatment now, they said, is to be charged with a felony or to end up in one of the specialty courts for issues like mental health or domestic violence.
“What ends up happening is if you’re not a criminal, and you don’t have Medicaid, [you] fall in the gaps,” said Debbie Thomas, CEO of the Walker Center, which runs a 48-bed treatment center in Gooding and outpatient care in Twin Falls. “It’s the ones that are working, lower socioeconomic levels, and they don’t get services because the Department of Health and Welfare is supposed to be that stopgap money.”
The state is closing the doors to new patients at a time when dozens of Idahoans are dying from accidental overdoses. In 2011, state officials tallied nearly 100 times that opioids, meth or other narcotics contributed to someone’s death. By 2016, that had doubled.
Officials with the Idaho Department of Health and Welfare say the cuts are temporary, that they don’t plan to seek help from lawmakers, and that spending could be ramped up again as soon as this spring. They said the cuts are a normal throttling of funds that Health and Welfare implements when its programs spend money faster than expected.
The state’s substance-use budget is “not an entitlement, so if we spend all of that money in two months, we’ll have 10 months without the money we need to serve,” said Ross Edmunds, who heads the agency’s Division of Behavioral Health. “We constantly have our hand on the faucet — the water being the funding we have available for treatment services — and we’re turning it up or turning it down, based on the spend-down.”
Providers said the past several months have been extreme — not the usual end-of-year squeeze.
“As providers, we all started realizing something was happening in September,” Thomas said. “The referrals [for new patients] were slowing down … and as providers we started asking questions like, ‘What’s different this year?’ Usually funding slows down in March, April, as you get close to end of the fiscal year. But this was the first quarter of the fiscal year.”
State officials say the shortfall was partly due to underestimating how much it would cost to take over treatment for people who were getting care through a federal grant that ended last spring. That grant provided $3.3 million in 2017 — about 20 percent of the state’s substance abuse allocations — to pay for treatment for several categories of people who couldn’t otherwise access it.
The state switched the federal-grant patients over to state programs in June. Program manager Rosie Andueza said that by October and November, it was clear that Health and Welfare would need to drastically crank down its spending for the rest of the fiscal year.
“We spent more money on that than we anticipated spending,” Edmunds said.
PREGNANT WOMEN, OPIOID USERS
The department wrote health care providers on Dec. 19 that “due to a variety of factors, we are experiencing an extreme budget shortfall this state fiscal year (July 2017-June 2018). As a result, we have no choice but to implement limitations to this spending and what it can support for the remainder of the fiscal year.”
Pregnant women and some low-income opioid users can still start treatment through federal grant programs, the memo said.
Some health care providers said the opioid grant, which opened to new patients in May, is well-funded but that its eligibility is so narrow that few people qualify. They said patients are so desperate for treatment that they attempt to get into the opioid grant by lying about their substance abuse — saying they use heroin instead of alcohol, for example.
The opioid grant served 270 people between May and early this month, according to Health and Welfare. It’s funded at $2 million for this fiscal year. The state had spent about $360,000 of that by the end of December, about halfway through the fiscal year.
People who previously would have been eligible for an IV drug user program or for services through BPA Health, the state’s substance abuse contractor, no longer can get into treatment.
The Dec. 19 memo said some patients could get access to “interim services” while they’re on a waiting list for treatment. Those services include coaching and peer support — “recovery support services that clients undergo before entering formal [substance abuse] treatment,” according to Health and Welfare.
“The department will implement cost reduction procedures for all other populations,” the memo said. “This will likely result in reduced access to services temporarily, but access will be restored as quickly as the budget permits,” the memo said. “This is a very difficult decision to make as we believe in the power of treatment and recovery support services in assisting individuals towards a life of recovery. Unfortunately, we find ourselves in a place where we simply have no other choice at this time.”
This isn’t the first time funding has run out early. Last fiscal year, the department opened up substance-use disorder services to the Medicaid gap population. But demand outweighed supply, and the department cut services by the end of the year.
Edmunds said Health and Welfare officials noticed the shortfall too late to ask the Idaho Legislature for emergency funds. If it looks like there will be another shortfall next year, the department will likely seek more funding, he said.
Officials do hope this year to pull from other Health and Welfare programs with extra funds — if any such surplus develops.
“State statute allows a 10 percent transfer” between accounts, Edmunds said. If one Health and Welfare program shows “a trend line” of not spending its full budget, the department could transfer money into the pots it uses for substance use treatment, he said. “But that means the money has to be underspent somewhere else, right?”
“Cross your fingers with me, because I keep hoping for a 10 percent,” Andueza said.
THOSE TURNED AWAY ARE ‘DETOXING IN THE ER’
Substance abuse treatment providers noted the cuts will drive up costs elsewhere.
People who don’t get treatment often end up in the hospital after they overdose, or in jails after they’re arrested for possession or failing a drug or alcohol test while they’re on probation, they said.
“You have clients who are detoxing in the ERs,” said Mark Senior, director of substance-use disorder services at Access Behavioral Health in Boise and Nampa. “These are lives that are impacted in the immediate term, so it’s a very serious thing, not having these funds.”
Thomas said Walker Center gets daily phone calls from people who don’t qualify for state programs anymore and cannot afford to pay out of pocket.
“It’s heartbreaking when people walk in, and they’re hopeless, they don’t know what to do,” Thomas said.
When told about the effects providers are citing, Edmunds said, “It’s those same providers who received all of these treatment dollars to serve all of these people in the months prior. … They are the ones who used all these resources to treat people; it just came earlier in the fiscal year.”
Providers stressed that while the current spending cuts are a shock, Idaho has long underfunded substance abuse treatment. They said the state hasn’t increased its payment rates for treatment despite rising costs of care.
“This is a tragedy for people, but this is an opportunity to turn lemons into lemonade, which is to help educate consumers and our legislators that this problem is not going away; it is actually growing,” Thomas said. “We wouldn’t treat someone with diabetes this way or someone with heart disease this way. … This is a time to talk about: What are we going to do with this state and not going to do with this state?”