Those who are in need of more intensive counseling as part of their drug or alcohol treatment program may soon get their wish. Maryland is just one state whose Medicaid program is being altered to encourage more intensive therapy and counseling for addiction patients. The changes are specifically meant to assist those who haven’t had access to traditional inpatient treatment, and have had to seek help from free-standing and hospital-based treatment centers. Baltimore is home to about 10,000 of these patients; and to encourage the aforementioned treatment centers to offer more counseling when patients need it, the state’s Medicaid agency is changing how it reimburses them. Rather than paying a flat rate for all patients, the federal-state health care program for the poor in March will begin to pay providers for as many counseling and related medical services as necessary for individual patients.
Other states like New York and California already adopt this fee structure, and New Jersey is gradually joining Maryland in its transition. The structural changes are the direct result of clinical recommendations from medical researchers who say that patients receiving a combination of medication and counseling fare far better than those who receive one or the other. Currently, Medicaid programs in 34 states pay for maintenance drugs like methadone, but far fewer pay for the much-needed counseling that can make the difference between relapse and ongoing success. These new rules are meant to provide financial incentive to treatment providers who offer patients targeted, individualized care programs. The more counseling a patient needs, the more money Medicaid will pay. Group counseling will be reimbursed at $29 a session, for example, while intensive individual counseling will be reimbursed at $125 a session. For patients who need only minimal counseling, Medicaid will pay a flat rate of $63 a week instead of the current rate of $81.60.
One of the fundamental elements of a quality treatment program is a diverse and well-rounded care plan that focuses on the physical and behavioral aspects of the addiction. While medication-assisted treatment (MAT) has been a critically effective resource in the treatment of chemical dependency, it is not, nor has it ever been, meant to replace or supplant other elements of treatment. Additionally, without rehab, detox is rendered much less effective because it’s simply helping patients to get clean while providing no behavioral safety-net or context for their problem. The bottom line is that treatment must address the behavioral and physical aspects of addiction in equal measure. These institutional changes are an encouraging signal that Medicaid programs are further realizing the need for bilateral, dual-focused treatment.