F or decades, if someone on Medicaid wanted

to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources.

Now, in a dramatic shift, the federal gov-ernment is considering chipping in, too. The agency that governs

Medicaid is proposing to cover 15 days of inpa-tient rehab per month for anyone enrolled in a Medicaid managed care plan.

But in Pennsylvania, those who work in the addiction field are not happy with that news. While it’s a good start, they say, 15 days of resi-dential care isn’t nearly enough time for many people addicted to her-oin, opioids, alcohol or other drugs to get clean

and stay that way.“Where they came

up with the 15 days, I don’t know, but it’s not based on research,” said Mike Harle, head of the nonprofit treatment pro-gram Gaudenzia, which serves about 20,000 patients a year in Penn-sylvania, Maryland and Delaware. In just 15 days, he said, you can’t expect to achieve a posi-tive outcome.

“Do you know how expensive that would be,

with no outcome?” Harle said. “We wouldn’t want to do it. We would not want to do it.”

Closing a loophole?Until now, the state of

Pennsylvania has used an obscure provision in the federal law to get federal reimbursement for much longer rehab stays for some people. Pennsylvania officials worry that the loophole will likely go away if the new Medicaid proposal is enacted.

In its guide to drug addiction treatment, the National Institute on Drug Abuse says: “Indi-viduals progress through drug addiction treat-ment at various rates, so there is no predeter-mined length of treat-ment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length.”

Dr. Jeffrey Samet, a professor at Boston Uni-versity’s Clinical Addic-

tion research unit, said there’s been little fund-ing for research that gets at the optimal length of an inpatient stay, in terms of effectiveness. And in the absence of good data, private insur-ance plans are all over the map in terms of how many inpatient days they will cover.

A good startConsidering that

Medicaid hasn’t funded residential treatment programs at all, up until now, 15 days is a good start, said Cindy Mann, a former top administrator at the federal Centers for Medicare and Medicaid Services, which governs Medicaid.

“Maybe it’s half a loaf for someone who needs 30 days,” said Mann, who now works for Manatt Health Solutions, a law and consulting firm. “But it’s half a loaf of new federal dollars that could be available.”

Chris Benedetto, a 30-year-old who started using heroin when he was 13 years old, of Scranton, Pennsylvania,

says he needed much more than 15 or even 30 days in rehab to kick his drug habit.

“I was really young,” Benedetto said. “I ac-tually was arrested in school.”

He bounced from school to probation to jail to rehabilitation. Benedetto said he knew how to play the treat-ment game, fooling his family and others that he was doing well, even when he was still using drugs, or about to slip.

Eventually, in 2009, Benedetto got into an inpatient facility and stayed there for five months of support-ive therapy, thanks to Pennsylvania’s looser interpretation of federal restrictions. Benedetto said the longer rehab stay is what finally en-abled him to kick his drug habit.

“For that amount of time, in that environ-ment, I will show up,” Benedetto said. He’s now been clean for more than five years and works as an assistant to an ad-diction counselor.come over?”

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Help for addiction

BIGSTOCK

By Ben AllenKaiser Health News/WITF

Medicaid to fund more drug, alcohol treatment

“Individuals prog-ress through drug

addiction treat-ment at various rates, so there is

no predetermined length of treatment. However, research

has shown unequiv-ocally that good

outcomes are con-tingent on adequate treatment length.”

National Institute on Drug Abuse