Addict Care To Change In N.H., Vt.

Thousands of New Hampshire residents with drug and alcohol problems will become eligible for insurance coverage next year under the new health care overhaul.

Meanwhile, Vermont’s substance abuse treatment programs could see added stress due to a greater number of people having health insurance after key parts of the federal health overhaul take effect.

That was the assessment yesterday among mental health experts in both states. The conclusion, which includes an Associated Press analysis of government data, comes as both states are getting ready to comply with sweeping changes in health care under the Affordable Care Act passed by Congress in 2010 and to go into effect next year.

The number of people seeking treatment nationwide could double over current levels, potentially swamping an already stressed system, an AP analysis of government data found. It’s expected that nationwide, between 3 million and 5 million people could become newly eligible to receive addiction treatment under provisions of the ACA.

In New Hampshire, for example, only 6,000 of the estimated 113,000 people who need treatment are getting it, according to federal data. Meanwhile, national statistics examined by the AP indicated that about 53,000 Vermonters — out of a population of about 626,000 — need substance abuse treatment; about 5,000 are getting it now.

The comments from state human services officials and treatment professionals came as The Associated Press released a national report showing new demand from newly insured people seeking substance abuse treatment could overwhelm existing programs in many areas.

New Hampshire

In January, the number of people with drug and alcohol problems who will be newly eligible for insurance will be roughly 11,770, — or 19,500 if the state also expands its Medicaid program, according to the AP analysis of data on addiction rates, the capacity of treatment programs and the provisions of the new health law.

That is a huge change, but the effects won’t show up overnight, in large part because a lack of insurance is not the only reason someone might not seek treatment, said Timothy Rourke, chairman of the Governor’s Commission on Alcohol and Other Drug Abuse Prevention, Intervention and Treatment. He pointed to the experience of other states that already have laws requiring substance abuse treatment to be covered the same way as other medical procedures.

“It doesn’t create a crushing wave all at once that overwhelms the existing system. It appears to be more of a trickle than a flood,” he said.

Rourke does expect the numbers to increase over time as addiction treatment services move “out of the shadows” of specialty care into mainstream medicine. And efforts are underway to both prepare existing agencies and explore opportunities for expansion, he said. “Certainly we need to be ready for it, but I don’t necessarily think we need to be ready for it Jan. 1,” he said.

New Hampshire’s current treatment system is small, and the state spends very little public money on it — $1.5 million a year, said Amy Pepin, policy director for the advocacy group New Futures. Waiting lists to get into treatment are common, and there is no comprehensive system aimed at prevention and early identification of problems like there is for other chronic diseases like diabetes. The state is trying to move toward what’s called a recovery-oriented system of care, which recognizes that people dealing with addiction need support over time, but budget constraints have hampered those efforts.

“Access to care is usually at a crisis point,” she said. “Which isn’t appropriate. That’s just the acute part of treatment, but it needs to continue after that.”

Abby Borgeois, director of the New Hampshire Alcohol and Other Drug Service Providers Association, said the state has a strong network of providers but they’ve been severely affected by budget cuts. Many are funded by grants, which have been diminishing.

“Medicaid expansion and the Affordable Care Act really provide some immense opportunities for providers and the people they serve. But I think with that opportunity also comes challenges,” she said. “As an association and as a network of providers, we’re really working hard to help our agencies build the capacity they need to respond to the expected changes.”

Much of the focus over the last year has been helping agencies prepare for the shift from a grant-funded model to a fee-for-service billing model, she said.

“There’s a good understanding that it is a work in progress, but we’re trying to do the best we can with what we know, and we do at least have the scope and resources to get the agencies started down the road to be doing this in the future,” she said. “You have to be optimistic about it. Of course we understand there are going to be challenges, but we’ll take those in stride and learn from them and work through them.”


Vermont officials and professionals involved offered mixed opinions about whether the influx of new patients will present a serious problem in the state.

Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, said the state has two factors working in its favor — the high percentage of residents, about 94 percent — who are covered by insurance now, and Vermont’s mental health parity law, which requires insurers to provide equal coverage for mental health and substance abuse treatment that they do for physical health.

But Vermont already is facing a shortage of professionals in some fields, said Floyd Nease, director of services integration at the state Agency of Human Services.

“There’s a 700-person waiting list in Chittenden County” of people seeking treatment for abuse of heroin and other opiates, said Nease, a former lawmaker who also served as executive director of the Vermont Association for Mental Health and Addiction Recovery.

Many of those not getting treatment simply have not made the decision to seek it, professionals said. The figures indicated that about 3,350 newly insured people were likely to seek substance abuse treatment in the state next year.

The state’s 278 treatment center beds had an occupancy rate of 87 percent, according to the most recent data, which were gathered from the Center for Behavioral Health Statistics and Quality.

At the Valley Vista substance abuse treatment center in Bradford, Rick DiStefano, vice president for clinical services, said his facility currently has no waiting list for women and adolescents, while men typically have to wait three to four weeks to be offered a bed.

He said most of the facility’s patients are funded by the state, through Medicaid or expanded Medicaid programs, and that the most common diagnosis is alcoholism.

DiStefano said a bigger worry for him than the availability of treatment beds and therapists is the availability of funding to support treatment for the publicly funded patients. He said his center is currently limited by the state to 15,400 patient-days per year that can be funded by Medicaid. If it goes over that limit, it is providing free care, he said.

“I believe it really is more of a funding issue than a need issue,” DiStefano said.