Snohomish County’s medical detoxification facility was planning to close as of yesterday. As I wrote in a column last week (“Obamacare’s Drug Problem”), Evergreen Manor’s facility in Everett was squeezed by an unintended consequence of the Affordable Care Act’s expansion of Medicaid. It was a canary in the coal mine — one of the first, but likely not the last, facility to close due to a sudden funding crisis.
Evergreen Manor had been getting $252 per patient per day to help ween off severely addicted people. Without acute medical detox facilities, there would still be addiction, and people trying to kick a habit. But they’d withdraw, most likely, in much more expensive hospital beds; $252 a day is cheap in comparison.
But as of January, Evergreen Manor and three other acute detox facilities began getting $160 a day, the amount paid for people on Medicaid. Evergreen Manor CEO Linda Grant warned the state and Legislature of the consequences: operating on a shoestring budget, it would have to close as of April 30.
After my column, the Department of Social and Health did a reassessment of Medicaid rates that are simply too low. Tuesday, it offered a reprieve.
Evergreen Manor – and similar facilities in King, Pierce and Thurston counties – now can get the $252 rate. The fix is complicated, and appears to shift some of the cost onto counties. But it is a reprieve nonetheless, allowing these vital public facilities to stay open while DSHS does a larger review of chemical dependency rates.
“I’m not sure why it took so long,” Grant told me. “The erosion continues but at least the safety net is in place.”
Although she is relieved, she notes that the rate change doesn’t help a similar financial crisis in Medicaid-funded inpatient and outpatient treatment. One King County outpatient facility has lost $65,000 since January. Another facility, Genesis House in the Madrona neighborhood, has closed. Others are threatening closure, unable to survive on a daily rate as low as $53.52.
Jane Beyer, the DSHS assistant secretary for behavioral health, said her staff is working on it. Of particular concern is our rural counties with one treatment provider struggling with Medicaid rates. “We’re still trying to see if there is anything to be done for single-provider counties,” she said.
I appreciate the effort, but the real fix lies with the Legislature. Before Medicaid expansion under the Affordable Care Act, about one-fifth of the people treated in state-subsidized treatment facilities were on Medicaid. Now, with expanded eligibility, about four-fifths are on Medicaid. Squeezing Medicaid rates to save state money is fine, but squeeze too far – and the state has – and the state is going to erode the safety net for addiction treatment.