The top human services official in the state, Sec. of DSHS, Kevin Quigley, authored a string of emails Thursday to defend his agency and put the blame squarely on the legislature for failing to adequately fund outpatient and detox drug treatment for addicts across the state who are poor.
"I will offer no apologies for DSHS’ efforts to address our mental health crisis. I lack the luxury of being able to be partisan about helping people," wrote Sec. Quigley. "Had the Governor’s budget prevailed, (and) hence we avoided $2MM in (drug treatment and mental health) cuts we could have better bridged us through to more sound rates. This was a sound strategy."
With the shift to the Affordable Care Act, thousands of patients getting treatment for addiction to heroin, meth, cocaine, alcohol and other drugs under a combination of federal and state payments have been switched to Medicaid. Medicaid rates are far lower than the actual cost of the services. Prior to January 1, DSHS was chipping in dollars to fill the funding gap for these services.
Now, publicly-funded service providers say they will be forced to deny Medicaid patients in the near future and some smaller agencies say they will have to close their doors altogether.
After service providers came out publicly to express their disappointment with DSHS for not raising Medicaid rates, Sec. Quigley wrote to a group of those providers and cc'd KING 5 on the communications.
"Just so it is clear to all, we at DSHS have made clear to the Legislature that this hole cannot be meaningfully fix(ed) in the DSHS budget. We have clearly articulated both the detox funding issues and the larger Medicaid/Non-Medicaid CD (chemical dependency) rates issues to the Legislature in writing and with visits and made it clear that within (DSHS divisions) all options are merely rob Peter to pay Paul options in an area where, in fact, greater funding is needed. Indeed, - and it is critically important that advocates understand this," said Quigley.
The providers found out in February the major financial impact that change is having on their agencies. The non-profit, Recovery Centers of King County, reports losing more than $40,000 of their scarce reserves in January and February to pay the difference for outpatient treatments.
Agencies that provide detox treatments are getting hard hit as well. At Evergreen Manor in Everett, they lost $63,000 in January and February to pay for outpatient and detox treatments. The CEO, Linda Grant, sent out an email today to alert the community that because of Wednesday’s news services will be cut soon.
“This is to give formal notice that we will begin the process of ending our contract to serve Medicaid (also called Apple Health) clients in detox in the very near future. I will keep you advised of the timelines but we cannot and will not continue a service that does not cover its cost. I am extremely disappointed and flabbergasted right now. All it would have taken is $250,000 to keep detoxes going. This is beyond belief,” said Grant.
Evergreen Manor's detox can last up to 6 days, but it took just 1 day for John Kearns' heroin addiction to start.
“Very first time I did it, I was hooked," Kearns said. “It’s gonna kill me. If I keep going out there, I will die.”
At just 10-years-old, Kearns tried his mom's alcohol and marijuana. He took her pills a couple years later. At 17, heroin was a cheap alternative.
Kearns credits the detox program with giving him the strength to buy a bus ticket to rehab. If the funding shortfall isn't fixed, he may be one of the last Medicaid patients the program accepts.
Evergreen Manor estimates 30,000 patients have passed through their detox rooms over the last 40 years.
“It’s a first step of a long staircase of recovery. It would be a shame if it got shut down,” Kearns said.
Without treatment services, administrators of human services at the county level project an immediate increase to the state and taxpayers in costs such as hospital emergency room stays and costs associated with crime.
“So now every one of those clients will end up in hospital ER at a cost, to the state and taxpayer, of $2,000-$4,000. Over the course of this year, it will cost millions to the taxpayer. (It) makes absolutely no sense. We heard (from our lobbyists) that the Legislature is looking to DSHS to fix it in their current budget. As you start declining admissions, this will cost shift not only to the hospital but to 911, law enforcement, jail and Fire District Emergency Medical Services. The $2,000-$4,000 per emergency room visit is the tip of the iceberg compared to the cost shift to local government,” said Ken Stark, Director of Human Services in Snohomish County and the former director of the Division of Alcohol and Substance Abuse at DSHS.
The providers told KING their lobbyists working on a fix with the legislature said DSHS did not make a formal request for the money in their current budget and that they would have to ask the governor to intervene at this late date.
Sec. Quigley said DSHS did its best to keep funding in place and that he and Ken Stark, Director of Human Services for Snohomish County, should have done more to communicate the needs to lawmakers.
"We all need to come to grips with the fact that we have none of us done the job we needed to do to educate the Legislature on the importance of CD funding and I think you need to reflect that you (Ken Stark) own that failure as much as I do. Perhaps justice will prevail and we will both be fired," wrote Quigley.
Stark said he believes there is still time in the final hours of the legislative session to avert what he calls a crisis.
"I'm still hopeful that the legislature will find a solution in the next 14 hours to come up with the money to ensure that detox centers across the state will remain open," said Stark. "Beyond that I hope the legislature will work with DSHS to increase payments (Medicaid rates) over the next year for all treatment services. But right now, detox is the most at risk."