Only about 1 in 10 people who need treatment for substance abuse in Washington state are getting that help, but officials believe that could increase dramatically next January when tens of thousands more become eligible for insurance because of the new federal health care law.
Lack of insurance and the cost of private care get most of the blame for almost half a million Washington residents not getting the addiction help they need.
The health care overhaul and the expansion of Medicaid that it calls for are expected to change that picture for as many as 166,000 people in Washington, according to state and federal health officials.
That would almost triple the number of people seeking treatment in the state, according to an Associated Press analysis of government data. The analysis compared federal data on the addiction rates in the 50 states among the uninsured, the capacity of treatment programs and provisions of the new health law.
In Washington, about 59,000 people are currently receiving treatment, according to the federal government. Another 47,000 people with substance abuse issues would be newly eligible for insurance in 2014. And another 119,000 would become eligible if the state expands Medicaid coverage, as expected.
That kind of increase in demand for treatment would create a big challenge for the system, said Jane Beyer, assistant secretary for behavioral health and service integration at the state Department of Social and Health Services.
Beyer is worried but not panicking.
“It’s a lot of people. No doubt about it,” she said.
Community-based creativity and entrepreneurial efforts by dependency treatment providers have tempered her concern.
For example, rural hospitals are starting to partner with chemical treatment providers to expand the number of places people can seek treatment.
“We are really trying to encourage creative contractual relationships,” Beyer said.
If someone can walk into a community health clinic and get chemical dependency treatment, they may also be less reluctant to seek that help, and society would benefit, Beyer said.
Washington has about 2,600 beds at treatment facilities, and those facilities have an occupancy rate of about 85 percent, according to the federal government.
Federal regulations concerning Medicaid reimbursements likely will force chemical dependency treatment centers to change their approach from big hospitals to smaller treatment centers, Beyer added.
Dr. Kalyan Dandala, medical director at Schick Shadel’s private 60-bed hospital in Seattle, says his industry is already moving in that direction.
He said his company is looking at expanding, with a focus on reaching people in outlying areas and starting an intensive outpatient program, but right now they usually operate with about 36 out of 60 beds occupied at any time.
Dandala expects that will change dramatically on Jan. 1, when federal law starts requiring mental health and addiction treatment benefits for more people and Medicaid is expanded.
“I think it’s going to hit us like a ton of bricks,” he said.
Washington has 575 certified agencies that provide outpatient and/or inpatient treatment for drug and alcohol dependency. Most of these are private agencies. The majority are in Western Washington.
Dandala and Beyer both said a shortage of addiction doctors and psychiatrists will also be a challenge after health care reform. Nurse practitioners and physician assistants will help fill the gaps in the short term, he said, but more doctors will be needed in the long run.
A treatment center near you
County-by-county numbers of certified alcohol and drug treatment agencies, according to the Washington Department of Social and Health Services:
Grays Harbor 12
Pend Oreille 2
San Juan 3
Walla Walla 5
State total: 575