A reduction in federal funding distributed by the state has caused substance abuse treatment providers to lay off staff members and turn away people who can't afford to pay thousands of dollars from their own pockets for residential care.
For example, Arkansas CARES, which treats pregnant women and mothers with mental illness and drug or alcohol addiction, can provide residential treatment for up to 10 women at its campus in Little Rock, but it had just three women in the program as of Friday.
Meanwhile, 41 women had been placed on a list, waiting to be notified when funding becomes available.
"To be honest, they'll die," said Kate Hardage, administrator of Methodist Children's Home, which runs the program.
"They will continue to use. You will have a higher rate of babies being born addicted, which [state Drug Director] Kirk Lane talks a lot about, and that's just increasing daily. You'll have an increase in homelessness. You'll have more kids in foster care."
The funding cut stems from a change in the way the state allocates the more than $13 million it receives each year through a federal block grant for substance abuse treatment and prevention.
Much of the money, along with state matching funds, is distributed to eight treatment providers throughout the state, which subcontract with other providers, such as Arkansas CARES.
In previous years, the state drew from more than one year's federal grant to pay the eight providers, Marci Manley, a spokesman for the state Department of Human Services, said in an email.
For the state fiscal year that ends June 30, the state decided to end that practice. The result was a reduction of about $4 million, to about $7.8 million, in the funding awarded to the eight providers to pay for treatment for people with incomes of up to 150% of the federal poverty level.
As of Friday, four of the eight providers had exhausted their block grant funds, and all but one of the others were on track to run out of money by the end of next month, Manley said.
The providers have received other money from federal grants to treat people with opioid addictions, but that money cannot be used for nonopioid users.
"In the state of Arkansas, our biggest problem is still alcohol and methamphetamine, and there's no money for that," said Jimmie Wooding, director of Harbor House in Fort Smith.
Better Community Development's Hoover Treatment Center in Little Rock hasn't received any money from the opioid grants, and its funding from the substance abuse block grant ran out in January, said Deborah Bell, Better Community Development's director of programs.
While some of the center's clients have opioid addictions, methamphetamine and cocaine users are more common, she said.
Her organization has a list of 53 people waiting for funding to become available. Only nine of its 24 beds for residential treatment were occupied Friday.
"Right now we have people who, when they call, we have to say, if they don't have any money, 'I'm sorry, we can't provide the service for you,'" Bell said.
With less revenue coming in from the grant, the center has had to eliminate its three-person kitchen staff, lay off two other support staff members and cut the hours of counselors and case managers from full-time to 20 hours a week.
"We've been operating on pretty much a skeleton staff," Bell said.
Providers said they understood that their block grant funding would return to its previous level when their new contracts start in July. However, the three provider contracts for fiscal 2020 that were reviewed by the Legislative Council's Review Subcommittee earlier this month were for amounts below what the providers received in previous years.
Ruth Allison Dover, director of Mid South Health Systems in Jonesboro, said her contract for fiscal 2020 is for $1,550,914, which she said is an increase of just $15,000 over the reduced amount it received this fiscal year for an area covering 20 counties in northeast and eastern Arkansas.
Manley didn't respond to emailed questions about the amount of funding the providers will receive in fiscal 2020.
Both Arkansas CARES and the Hoover Center are subcontractors to North Little Rock-based Recovery Centers of Arkansas, which holds a state contract to provide substance abuse treatment in Pulaski, Saline, Lonoke and Prairie counties.
Recovery Centers of Arkansas Director Carole Baxter said her organization stopped accepting new clients for treatment using block grant funds in late March because of a lack of funding.
Its opioid grant funding ended this month, after the state redirected the money, saying Recovery Centers of Arkansas wasn't spending it fast enough.
Baxter and other providers said they offer free outpatient counseling and other services to people who are placed on a waiting list because of a lack of funding. But she said the delay in admitting a client for residential treatment can hurt their chances of overcoming their addiction.
"When people make the decision, when they finally say, 'I need some help, I've got a substance abuse problem,' it's pretty important they get into treatment quickly," Baxter said.
Years ago, it was common for substance abuse providers to run out of money at the end of the fiscal year, Baxter said. That changed as more people gained health coverage under the 2010 Patient Protection and Affordable Care Act, which mandated coverage of substance abuse by plans sold through healthcare.gov and to people who gained coverage under Medicaid expansion.
The state's overhaul of mental health benefits provided by the traditional Medicaid program, which covers poor people who are elderly, disabled, children in low-income families and some poor parents and pregnant women, in July 2018 included an expansion of substance abuse coverage.
But the program still does not pay for residential treatment. And some substance abuse providers who have applied to become Medicaid providers months ago still haven't received approval to begin billing the program.
Wooding said Harbor House has fared better than some other providers because, unlike most of them, it has agreements allowing it to bill private insurance insurance companies for residential treatment. Many of its clients qualify for coverage in private, subsidized plans under the state's expanded Medicaid program, known as Arkansas Works, which is available to people with incomes of up to 138% of the poverty level.
After her organization ran out of block grant funds earlier this year, it began tapping a $60,000 grant from the United Way. That grant ran out earlier this month, Wooding said.
While it waits for funding from another United Way grant, which Wooding said she expects any day, the organization has treated some clients for free and put others on a waiting list.
Some potential clients' "symptoms weren't as bad as some of the others," she said. "If they can hold on a little longer, then we have to turn them away."
At Arkansas CARES, which stands for the Center for Addictions Research, Education and Services, Hardage said she's working on a proposal with state officials that would give her organization access to money from one of the opioid grants.
That would allow Arkansas CARES to provide residential treatment to at least 26 of the women on the waiting list -- those who identified an opiate as their primary drug of choice, Hardage said.
She said her organization is gathering information about other women on the list who may also use opioids -- making them potentially eligible for funding under the opioid grant -- even though they didn't list it as their drug of choice.
Arkansas CARES offers a 120-day program allowing mothers to live with their children while undergoing counseling and taking classes. Mothers with open child welfare cases can qualify for funding through the Human Services Department's Division of Children and Family Services, Hardage said.
Mike Knickerbocker, director of New Beginnings Center for Alcohol and Substance Abuse in Warren, said earlier this month that his organization ran out of block grant funds in January but hadn't turned away any clients.
Instead, the organization has been dipping into its reserves and laid off a half-dozen staff members, including counselors whom Knickerbocker said he expects to hire back after the contract for the next fiscal year starts in July.
"We've just kind of tightened our belt," Knickerbocker said.
SundayMonday on 05/27/2019