Politico features article on Efforts to Save Funding for Certified Community Behavioral Health Clinics

Lawmakers scramble to save funding for opioid treatment at mental health centers

By Brianna Ehley

02/15/2019 02:02 PM EDT

A $1 billion Medicaid pilot program providing opioid addiction treatment at mental health outpatient centers is likely to run out of money next month unless lawmakers on Capitol Hill find a way to replenish it.

More than 300,000 low-income people would lose access to services in eight states if funding for the two-year demonstration expires. After sponsors failed to attach the money to this week's congressional spending deal, they are looking for other must-pass legislation, which could include a bill to raise the debt limit or a measure setting spending caps for fiscal 2020.

"We are looking at every (legislative) vehicle," said Sen. Debbie Stabenow (D-Mich.), who developed the demonstration with Sen. Roy Blunt (R-Mo.). It gives extra Medicaid funding to at least 78 clinics that are certified community behavioral health centers and working to integrate mental health and addiction treatment into primary care.

A funding extension for the program failed to make it into a sweeping bill to address the opioid crisis because of cost concerns. The CBO at the time estimated that expanding the program to a total of 10 states and extending it for one year would cost $510 million. Lawmakers are now considering a similar measure and sources involved in discussions dispute CBO's projections and say it would cost closer to $400 million.

If that fails to get support, lawmakers are floating the possibility of an emergency funding bill to keep about $56 million flowing to the eight states through September to give negotiators more time to work on a full extension.

Clinics in Oklahoma and Oregon, both hit hard by drug addiction, are expected to be the first to run out of the money at the end of March unless Congress acts. Clinics in the six remaining states: Pennsylvania, Nevada, New York, New Jersey, Minnesota and Missouri, will run out of money at the end of June.

The clinics will remain open, but the special designation which gets them enhanced federal matching funds for treatment would disappear, potentially resulting in thousands of layoffs and diminished care, according to clinic operators.

"We're very worried," said Verna Foust, the CEO of Oklahoma-based Red Rock Behavioral Health Services. She estimates roughly 5,000 people stand to lose access to their services in more than a dozen clinics across the state and upwards of 125 health providers could be laid off.

Stabenow told POLITICO she is starting to rally support for legislation she and Blunt will introduce to extend the program for two years and expand it to other states. Reps. Doris Matsui (D-Cal.) and Markwayne Mullin (R-Okla,) are planning to introduce companion legislation in the House.

Mullin and Stabenow both acknowledged cost is a factor. So, too, is the legislative calendar, which offers limited opportunities to pass the funding extension. Still, they contend addressing the drug epidemic and mental health crisis is a priority for both parties.

Last year's opioid bill emphasized the need to expand access to treatment, including medication assisted therapies, which are considered the gold standard of care. The pilot program pays for such treatment available to more than 9,000 people in the eight states, according to the National Council for Behavioral Health.

"It definitely undermines the ability to provide ongoing opioid treatment services," Stabenow said.

Sponsors two years ago hoped to make the pilot program nationwide but dropped the idea over cost concerns. They now find themselves arguing for its survival, pointing to the need for a steady, dedicated stream of funds.

"This critical program must be extended so it can continue to serve individuals needing mental health or substance abuse treatment," said Matsui, who co-sponsored the original House legislation creating the demonstration. "Congress must act now to ensure that funding does not lapse."

Advocates say the demonstration is a crucial first step toward integrating mental health and addiction treatment into primary care services. They say this approach is more sustainable than providing behavioral health services through grants — a process that is favored by Congress.

Clinics participating in the demonstration must offer a variety of required services including addiction and mental health screening, 24-hour crisis services, care coordination and recovery services.

"The combination of the requirements for the program, coupled with the payment methodology make this kind of investment possible," said Chuck Ingoglia, senior vice president of policy for the National Council for Behavioral Health, which provides technical assistance to the clinics. "Providers don't usually expand capacity on grant dollars as these are too volatile and unpredictable."

According to a survey of clinics, conducted by National Council for Behavioral Health, 87 percent reported an increase in patients — the vast majority had an increase of up to 25 percent. Roughly 68 percent of clinics reported a decrease in patient wait times, while 30 percent have seen wait times remain steady. A federal evaluation is forthcoming.

Clinicians agree that the program shows promise but say the first two years of the demonstration was spent on building infrastructure and hiring staff. They say the program should be extended to realize its full potential.

"We need more time," said Jeffrey Eisen, chief medical officer for Oregon-based Cascadia Whole Health Care. "We already have preliminary data that suggests that were headed in the right direction."

Oregon is preparing to submit a state plan amendment to CMS to continue the demonstration as a contingency plan if Congress doesn't extend the program. Mullin said Oklahoma is looking at similar options.

"We're going to try to do what we can to keep this running," he said.

Still, the uncertainty has clinic operators concerned.

"We spent a lot of time and money changing our system," said Foust of Red Rocks Behavioral Health Services. "To have to turn the clock back to where we were, it's depressing."