Heroin Addiction: Treatment Funding

LFDA Editor

Click here for information about the state of heroin use and abuse in New Hampshire. 

In Brief:

  • Under the Affordable Care Act, the majority of private insurance plans must cover substance abuse treatment services. This also applies to Medicaid and Medicaid expansion plans. 
  • Demand currently exceeds capacity for residential substance abuse services and intensive outpatient counseling in New Hampshire. 
  • Availability of substance abuse services is not evenly distributed through the state, with some regions lacking local options for treatment. 
  • Pro: Heroin treatment programs represent a smart investment, saving lives and reducing crime.
  • Con: Drug treatment programs can serve as a ‘revolving door’, with patients relapsing and returning for additional services. 

Issue Facts:

Treatment Options: 

Heroin addiction can be treated through behavioral therapies or medication, or a combination of both. 

  • Medications like methadone can reduce withdrawal symptoms and craving or block opioid receptors in the brain so that heroin no longer has an effect on the user. 
  • Naloxone (Narcan) counteracts the effects of a heroin overdose and is often used as an emergency treatment.
  • Both cognitive behavioral therapy and contingency management therapy have been used to effectively fight heroin addiction.

Both types of addiction therapies can be delivered through either residential or outpatient programs. 

Funding for Treatment in NH: 

According to Donald West at the Dartmouth-Hitchcock Medical Center, inpatient heroin addiction treatment can cost roughly $14,000 to $15,000 per month. Intensive outpatient care costs approximately $3,000 to $4,000 per month. 

Private Insurance

The Affordable Care Act prevents insurance companies from turning away applicants based on their history of substance abuse, and requires that all health care plans offered through state or federal insurance exchanges cover substance abuse treatment services at a level comparable to coverage for physical health services.  

Medicaid 

Medicaid expansion patients (under NH Health Protection Program) are covered for a range of substance abuse treatments, from counseling services, methadone or buprenorphine administration, and outpatient care to residential programs. Traditional Medicaid subscribers (under NH Healthy Families) may access a more limited range of services, which does not include ambulatory detox services. Limits and requirements for coverage vary. 

Alcohol Abuse Prevention and Treatment Fund 

In 2000, the Legislature authorized the creation of a dedicated fund for alcohol and drug abuse prevention, treatment and intervention (RSA 176-A:1). The fund is scheduled to receive 5% of profits from sales at state liquor stores, as well as a portion of funds from fines and penalties related to alcohol abuse or violations of alcoholic beverage laws. However, the fund only received its full statutory appropriation in 2003, the first year it was created. Since then, a portion of funds has regularly been diverted to the general fund or other line items. 

Availability of Treatment in NH

Insurance coverage for substance abuse treatment does not necessarily mean that such services are readily available. A 2014 survey by the NH Department of Health and Human Services found that: 

  • Demand currently exceeds capacity for residential substance abuse services and intensive outpatient counseling. 
  • The availability of services is not evenly distributed through the state.
  • Some regions lack any residential treatment centers.
  • Others have no providers of medication assisted treatment, or only one for the region.
  • Some regions have low numbers of licensed drug counselors.     
  • Not all providers accept insurance or Medicaid, with 22% of independent providers and 13% of private practice groups only accepting self-pay patients. 
  • Many service providers plan to expand their capacity and/or range of offered services in the near future. 

Possible Policy Responses

Suggested policy responses related to the expansion of heroin addiction treatment funding in New Hampshire include: 

  • Fully funding the Alcohol Abuse Prevention and Treatment Fund
  • Continuing to renew Medicaid expansion
  • Increasing substance abuse benefits for traditional Medicaid patients
  • Simplifying licensing requirements for substance abuse treatment centers
  • Increasing state subsidies for uninsured or underinsured patients

Related issues 

Heroin Addiction: Law Enforcement
Affordable Care Act: Medicaid Expansion
Prescription Drug Abuse

PROS & CONS

"For" Position

By LFDA Editor

"NH should provide more funding for heroin treatment."

  • Heroin treatment programs represent a smart investment, saving lives and reducing crime by reducing incarcerations and the risk of reoffending.
  • Wait lists mean that patients seeking help may be turned away when they are in most need of assistance.
  • Additional subsidies would help to expand capacity and subsidize the cost of treatment for those who cannot afford it.
  • Funding is necessary to provide important services not normally covered by Medicaid or insurance, such as recovery programs or early intervention. 

"Against" Position

By LFDA Editor

"More funding is not the answer to NH’s heroin problem."

  • More money does not necessarily equal better results, and lawmakers should acquire data on the effectiveness of programs before approving increased funding.
  • Drug treatment programs can serve as a ‘revolving door’, with patients relapsing and returning for additional services.
  • Heroin addiction is a private problem based on an individual’s choice, so it should be an individual’s responsibility to find the funds for treatment.
  • In tight budgetary times, there are higher priorities for limited state dollars than funding heroin treatment. 

LEGISLATIVE HISTORY

Signed by Governor

Requires health carrier network adequacy rules to include access to providers for persons with substance use disorder. This bill also requires health carriers to notify covered persons of their rights, including the ability to appeal decisions and seek care out-of-network.

Signed by Governor

Declares that if substance use disorder services are a covered under a health benefit plan, prior authorization for prescribed medications for a substance use disorder is only required once a year.

Signed by Governor

Makes it easier for grandparents to get guardianship of grandchildren as the result of a parent's substance abuse or dependence.

In Committee

Repeals the state definition of "mental illness" and replaces it with "mental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition." This bill also allows involuntary commitment for opioid addiction.

Tabled in the Senate

Increases the percentage of the previous year's gross liquor profits deposited into the Alcohol Abuse Prevention and Treatment Fund, from 1.7% to 3.4%.

Signed by Governor

Legalizes trace amounts of drugs in needles, and authorizes persons other than pharmacists to dispense hypodermic syringes and needles. This bill would allow needle exchange programs.

Killed in the House

Creates a dedicated fund for the bulk purchase of narcan and naloxone, so that the state can offer Narcan and naloxone at a discounted price. The fund would be supported by public and private sources including, but not limited to gifts, grants, donations, rebates, and funds from agreements or settlements received by the Department of Justice.

Killed in the House

If a first responder administers Narcan to a youth age 14-17 for an overdose, this bill requires the state to assess whether the youth should be placed at the Sununu Youth Services Center.

In Committee

Authorizes community-based needle exchange programs and requires the Department of Health and Human Services to develop rules for such programs.

Killed in the House

Requires treatment and recovery programs for substance abuse disorders to use an integrative approach, including homeopathic remedies, when treating patients.

Tabled in the House

Establishes the position of licensed alcohol and drug counselor in the Department of Safety. The person holding the position shall be responsible for establishing a training program for fire and emergency medical services personnel and developing a pilot program through which local communities hire licensed alcohol and drug counselors.

Killed in the House

Establishes a commission to study long-term peer-to-peer recovery services in New Hampshire.

Signed by Governor

Requires public schools to provide age appropriate drug and alcohol education to pupils in kindergarten through grade 12.

Signed by Governor

Makes some changes to the licensing of alcohol and drug counselors.

Signed by Governor

Establishes the statewide drug court grant program.

Signed by Governor

This bill includes many regulations aimed at combating heroin and prescription drug abuse. For example, this bill increases the penalties for abusing fentanyl and provides funding for an upgrade to the Prescription Drug Monitoring Program.

Interim Study

Requires the insurance commissioner to investigate insurance carriers for conduct which may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Signed by Governor

Provides that evidence of a parent's opioid drug abuse creates a presumption of harm under the Child Protection Act. The bill also permits the court to order periodic alcohol or drug testing and provides that the parent may be responsible for the cost of such tests.

Signed by Governor

Revises prior authorization requirements under the managed care law for substance use services.

Killed in the House

Appropriates $51,520 in the biennium ending June 30, 2017 to the TIGER (educational theatre) program at Plymouth State University and establishes the heroin and opiate prevention education (HOPE) grant program for public high schools.

Interim Study

Makes a general fund appropriation of $2 million to the Housing Finance Authority to fund supportive housing for persons with substance use disorders.

Tabled in the House

Requires the Department of Health and Human Services to evaluate the cost effectiveness of alcohol and drug abuse prevention, recovery, and treatment programs which receive state or federal funds, and requires organizations receiving such funds to spend the money on the most cost effective programs.

Signed by Governor

Originally written to make various changes to the Prescription Drug Monitoring Program. The Senate amended the bill to instead create a commission to study the overdose-reversing drug Narcan.

Killed in the House

Allows the county convention in each county to establish heroin use prevention and treatment programs.

Interim Study

Requires hospitals in Hillsborough county to offer patients who have received Narcan for a drug overdose an opportunity to speak with a recovery coach or receive contact information for a recovery coach.

Killed in the Senate

Expands drug take-back programs to include drugs such as cocaine.

Killed in the House

Constitutional amendment that prohibits use of money from the substance abuse treatment fund for anything other than substance abuse treatment.

Signed by Governor

Increases access to overdose-reversing drugs such as Narcan by allowing doctors to pescribe to friends, family members of addicts.

Killed in the House

Establishes a committee to study opioid misuse.

Should NH increase funding for heroin treatment programs?

FOR
REPRESENTATIVES

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UNDECIDED
REPRESENTATIVES

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AGAINST
REPRESENTATIVES

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Comments

Mark OBrien
- Haverhill

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Issue Status

In August, the Executive Council authorized over $1.2 million in state contracts aimed at fighting the opioid addiction crisis, including additional funding for inpatient and intensive outpatient treatment. 

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