As an ever increasing number of people seek help with alcohol and drug addiction, a payment loophole is preventing many of those patients from getting timely treatment. That’s in part because Medicaid does not reimburse private providers who treat their patients for addiction, unless they are also diagnosed with a mental illness.
But not every patient who abuses alcohol or drugs is mentally ill.
That’s why Dean Corcoran, a counselor with a private practice in St. Johnsbury, faces a dilemma when a new patient shows up with an addiction, but without obvious symptoms of mental illness.
“As a dual licensed person, when I submit a mental health diagnosis to Medicaid, I get reimbursed with no question. If I submit a number that corresponds to substance abuse diagnosis I get it bounced back saying that they can’t pay it,” Corcoran explained.
Frankly, someone who has made the tough decision to come for treatment, especially if they are facing heroin or ... any kind of opiate withdrawal, which is pretty daunting, at this point they throw up their hands because they feel impatient and frustrated, and let it go." - Dean Corcoran, St. Johnsbury substance abuse counselor
Corcoran says as long as a person is hooked on alcohol or drugs, diagnosing mental illness can be difficult. Sometimes the addiction has to be treated before underlying issues can be identified. He says his private practice is busy, so he is not necessarily seeking more Medicaid patients, though he never refuses them. But if they are seeking treatment only for an addiction and not for mental illness, he has to refer them to a state approved program, such as Northeast Kingdom Human Services, which can bill Medicaid for every service they provide.
“And God bless them, they are hard working people and they are probably understaffed, and they tell this person 'okay, but we have a waiting list,' ” Corcoran said.
And so sometimes the patient gives up.
“Frankly, someone who has made the tough decision to come for treatment, especially if they are facing heroin or opiate, any kind of opiate withdrawal, which is pretty daunting, at this point they throw up their hands because they feel impatient and frustrated, and let it go,” Corcoran said.
The state is aware that private providers are being excluded, while larger programs are included in the state’s approved list of treatment options.
Barbara Cimaglio is Vermont’s deputy commissioner for Alcohol and Drug Abuse Programs. She says the opioid epidemic needs a response from a larger workforce that includes private providers as well as state approved programs.
“This has come up. There was legislation introduced last session that allowed licensed alcohol and drug abuse counselors to bill. It did not get all the way through the process. But I think there’s a recognition that we need to make this change, especially in these times where we have so many people with addictions that are seeking help,” Cimaglio said.
That legislation would be welcome, says counselor Dean Corcoran. But if it doesn’t succeed, he would like to see at least a pilot program that folds in a few private providers, to see if they can make a dent in the backlog for treatment.
