www.WDIO.com

33,000 Wis. Addicts Soon Eligible for Insurance

Posted at: 04/16/2013 1:15 PM
Updated at: 04/16/2013 1:16 PM
By: DINESH RAMDE, Associated Press
dramde@ap.org

null

MILWAUKEE (AP) - More than 30,000 uninsured Wisconsin residents with drug and alcohol addictions will become eligible for insurance when the health care overhaul goes into effect in January, but persistent staff shortages and a lack of beds means those patients still might not get the help they need.

There are about 1,230 beds at Wisconsin treatment facilities, and one-quarter are empty, in part because health officials say they have difficulty finding qualified therapists. Other treatment centers say they are reluctant to add staff when they don't know yet how much insurance programs will reimburse them for treatment.

That could mean thousands of addicts won't get the treatment they need even though the law entitles them to covered care.

Aurora Psychiatric Hospital in suburban Milwaukee has five addiction psychiatrists on staff, barely enough to treat the estimated 140 patients who are seeking services at any given time, hospital president Peter Carlson said in an email. It's already so difficult to find qualified therapists that it's hard to think about expanding even further, he added.

"There is an industry-wide shortage of addiction psychiatrists," Carlson said. "At our current staff levels, it is challenging to meet the community demand for addiction treatment."

About 541,000 Wisconsin residents, or nearly 12 percent of the state population, need treatment for substance abuse, according to the federal Substance Abuse and Mental Health Services Administration. Of those, 61,000 are currently receiving treatment.

Once the Affordable Care Act kicks in, an estimated 33,356 addicts would be newly eligible for insurance in 2014. That number would rise to 63,592 addicts if the state were to expand Medicaid, but Gov. Scott Walker has said he plans to reject federally funded Medicaid expansion and instead tighten income eligibility for the program.

Amy Lindner is president of the Milwaukee-based Meta House, a substance-abuse treatment program for women that also provides services for children. The facility has beds for 35 women and 17 children in residential treatment, but 10 beds are going unused because the center - which gets much of its funding from state and federal grants - can't afford to hire staff to care for 10 additional patients.

She too said her program wasn't planning an immediate expansion because of the new health care law. Her grant funding wouldn't increase with more patients, and it's unclear how much of the cost insurers would pay, she said.

"If insurance will only pay $8 for someone to provide Master's (degree)-level work we won't be able to keep the doors open," Lindner said. "It would be beneficial to us if women had insurance, but if you're losing money by treating them, it doesn't make sense."

Lindner also expressed concern that the county or other levels of government might cut their subsidies under the assumption that insurance was picking up more of the cost. That could counteract any gain in revenue from having insured patients.

Officials at other rehab centers shared Lindner's hesitation.

Appleton-based Lutheran Social Services of Wisconsin and Upper Michigan has 16 outpatient clinics in Wisconsin, along with facilities in the Eau Claire area that provide in-patient care as well. Director Signa Meyers said it's hard to make concrete plans when it's unclear how many new patients will seek treatment.

"Just because someone has an addiction and insurance doesn't necessarily mean they're going to seek help," Meyers said. "We don't want to ramp up now and then end up having to lay people off."

Meyers said there are alternatives to hiring more therapists or acquiring more beds.

For example, her clinics have begun moving patients from individual therapies into group settings, which can prove more effective for their treatment and also decrease the workload on each therapist. She's also working on hiring more bilingual therapists.

"As far as what happens next year, we're waiting until we get closer to Jan. 1," she said. "You have to be prudent about making any changes. But fortunately, that's not a decision we need to make today. After all, it's still April."

(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)