Texas faces a shortage of substance use disorder providers


AUSTIN (Nexstar) — As state officials and lawmakers continue working to address substance use disorders, they’re faced with another challenge: a shortage of providers.  

According to statistics provided to lawmakers during the interim, Texas has the third lowest ratio of providers, with around 17 per 1,000 adults with a substance use disorder.   

“One of the challenges has been in the area where there’s been a misalignment between reimbursement rates and the cost of providing services,” Sherry Blyth with Integral Care said. “To remain financially solvent, those need to be closer together.”  

Blyth is the director of crisis services, adult substance use treatment and justice initiatives at Integral Care, which is Travis County’s mental health authority. The organization provides direct services for mental illness, substance use disorder and intellectual and developmental disabilities and partners with other providers in the community, like Austin Recovery. 

“The reimbursement rates vary extremely,” Laura Sovine, executive director of Austin Recovery, said in an emailed statement. “A very nice commercial insurance plan will pay $500 per day for residential treatment, whereas a traditional Medicaid plan will only pay $85 per day.” 

Sovine says the state rate, from Health and Human Services Commission substance use disorder grant dollars, is $108 per day for a single person and $208 per day for a mother with a baby. For a non-profit provider like Austin Recovery to remain viable, the organization’s only way to afford to take clients with Medicaid “is to also take clients with the upscale commercial policy,” Sovine said.  

Sovine said there are only two non-profit providers in Austin providing residential treatment for substance use disorder using a combination of state dollars and Medicaid dollars, or from one of the sources.  

“Local government contracts and local foundations pay Austin Recovery a reimbursement rate of $250 per day which is a breakeven reimbursement for us,” she explained. 

She says the organization heavily relies on community support, fundraising and partnerships like St. David’s Foundation, the City of Austin, Integral Care and the SIMS Foundation, as well as others who are paying for substance use disorder treatment at a fair rate. 

Although the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) is supposed to prevent health plans and insurance companies from imposing less favorable coverage limitations on those services when compared to medical or surgical treatments, patients still sometimes have trouble getting care.  

“Providers can be faced with making hard decisions in the area of remaining financially and fiscally responsible,” Blyth said.  

Integral Care had to close one of its residential facilities around two years ago, but it has turned to other external partners to provide services to people in need. Austin Recovery is also feeling the impact, Sovine said. 

“Austin Recovery has a waitlist of over 70 people who are waiting on a grant-funded bed,” she said. 

“The expectation is that a Medicaid provider of residential treatment should be able to run a 24-hour facility with extremely vulnerable individuals, staffed by advanced license mental health providers and medical personnel, including a doctor, for just over $3 per hour,” she added. “The reimbursement rates must be addressed so that all providers may expand capacity for service, as 95 percent of the indigent population in Texas does not have access to substance use disorder treatment.” 

Other ideas to address need

Bill Newcomb, who is a peer support specialist at Integral Care, does what his title suggests. Newcomb was diagnosed with bipolar disorder more than a decade ago and was hospitalized for a few weeks. Once he left the hospital, he joined a support group and eventually started working with peer support groups in his community.  

“A huge number of the people I work with also have co-occurring substance abuse disorders which really go hand in hand with mental health issues,” Newcomb said. “You can’t treat one without really dealing with the other.”  

Students from the Dell Medical School at the University of Texas at Austin also can get hands-on experience through Integral Care’s rotation program. Michael Measom, a second-year medical student, saw first-hand how his service could positively impact clients. He spent a few days working at the methadone clinic and helped a client with housing needs.   

“The need is huge,” he said. “There are so many people that can really, really benefit from the resources that we can put into the program. If we don’t really be proactive and go out there and try to find people and help people, a lot of those people are going to fall through the cracks and not be touched by our healthcare system.”  

“One of the reasons we’re excited about having students here is that we hope this experience, we know it will excite them and [have] them want to be a part of this industry, helping people in our community and local community-based mental health and substance abuse care,” Blyth said.  

Integral Care and Dell Medical School are currently discussing a future fellowship program for students as well. Several pieces of legislation related to mental health access have been filed so far in the 86th legislative session. Sen. Jane Nelson, R-Flower Mound, is the lead author on a bipartisan bill that would enhance collaboration between health-related universities and community mental health providers. Rep. Garnet Coleman, D-Houston, has filed a bill that contains several provisions related to coverage for mental health conditions and substance use disorders.  

Editor’s note 02/20/19: A previous version of this story incorrectly reported that the state reimbursement rate was $180 for a residential treatment that costs $475-$500. The numbers have been corrected with additional information from Austin Recovery. 

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