Advocates who have been calling for comprehensive treatment, recovery and decriminalization policy reforms to address the state’s opioid crisis say they are grateful to finally see movement on a key reform that was ignored during the two terms of former Governor Paul LePage.
In her budget, Governor Janet Mills has proposed increasing weekly Medicaid reimbursements for providers of medication-assisted treatment (MAT) to people suffering from opioid-use disorder.
“In 1995, which is when the very first clinic opened in Maine, the weekly [reimbursement] rate [to a provider] was $80 a week,” Jim Cohen, a spokesperson for the Coalition of Methadone Clinics, told lawmakers at the state house Tuesday. “[The weekly reimbursement rate] is basically about the same as it was 24 years ago.”
In Mills’ first proposed two-year budget, currently under review in the legislature’s Appropriations Committee, $8 million is dedicated to address the opioid crisis response — $2.5 million of which would be allocated to increase the MaineCare weekly reimbursements to MAT providers.
While studies show that treating people with medications like methadone and buprenorphine cuts overdose and opioid deaths among patients by half or more, advocates say that access to these critical drugs has been inaccessible for many people because there simply are not enough providers to meet the need.
With reimbursements rates so low, many medical facilities have seen no incentive to provide the treatment. Across the entire state, the only clinics currently offering MAT to MaineCare patients are in Portland, Bangor, Lewiston and Calais — leaving affected Mainers in large swathes of the state a long distance from support.
“For a treatment modality that relies on regular transportation, that means access to treatment is limited,” Cohen said.
With the proposed increase for reimbursements, however, there is now hope that more facilities will be inclined to offer the treatment.
“One of the things that we saw midway through LePage’s terms in office was that by reducing the Medicaid rolls, he effectively put a lot of substance-abuse treatment providers out of business. Hopefully, this is the start of trying to really build that network back up in order to meet the treatment need that’s out there in the community,” said Maine Health Equity Alliance director Kenney Miller, who last month, as part of a coalition of advocates and lawmakers, released a package of policy recommendations that outline a new path to addressing the state’s opioid crisis.
He added, “All pathways to recovery are important. But [medication-assisted treatment] has proven to be incredibly effective in helping people towards achieving some level of stability.”
Miller also expressed support for Mills’ proposal to allocate $5.5 million in the next two-year budget from the “Fund for a Healthy Maine,” typically reserved for tobacco cessation programs, for the governor’s director of opioid response Gordon Smith to use as discretionary funding. However, it is unclear how much of that will go toward harm-reduction programs.
Health department ‘screams out for innovation and new approaches’
While increased funding for MAT is a crucial component to addressing the crisis, Miller and other recovery advocates say the state is still just regaining ground lost during the LePage administration.
State Rep. Drew Gattine (D-Westbrook), House chair of the legislature’s Appropriations Committee, echoed this sentiment.
Questioning Maine Health and Human Services commissioner Jeanne Lambrew about the larger scope of the governor’s first health budget Tuesday, Gattine expressed concern over what he felt was a number long-underfunded programs in her department, such as child, mental health and recovery services.
“These are areas that scream out for innovation and new approaches,” Gattine told Lambrew. “Overall, there is not a lot of initiatives in this budget for these.”
Miller said the budget’s harm-reduction initiatives like funding MAT will make a difference, but are not going to end the crisis alone. He argues that policymakers need to do more to shift budget priorities from criminal justice responses to sustained, health-centered intervention.
“We still have work to do enhance trauma-informed care for people who are ultimately the victims of complex trauma and adverse childhood experiences,” he said. “It’s not that we don’t have the resources, it’s a matter of political will.”
(Photo: Joe Raedle | Getty Images)
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