With 20 open slots for chemical dependency treatment in Billings, about 160 people are on the waiting list.
The obstacle to treatment access is a federal law that inexplicably restricts the capacity of addiction treatment centers serving Medicaid patients. The law says Medicaid can’t cover treatment in a facility that has more than 16 beds. Rimrock, a private nonprofit in Billings, has a center with 42 beds, that serves privately insured or private pay patients.
Treatment for Medicaid patients can only be covered if they are treated in one of Rimrock’s “residential” treatment programs that operate in several houses with fewer than 10 participants. The treatment is the same at the larger facility and the houses, but the houses are more expensive to operate, according to Rimrock CEO Lenette Kosovich. The 42-bed center is often half empty while the 60 residential slots are full with long waiting lists.
Women have usually been the majority of people waiting in Billings for addiction treatment. Some are pregnant and many have young children. Parental substance abuse, particularly methamphetamine addiction, is a factor in most Yellowstone County foster care cases. It’s not unusual in our community for babies to be born with illegal drugs in their tiny bodies, and to be immediately placed in foster care for their safety.
Rimrock plans to open a new house dedicated to serving pregnant women. Kosovich told The Gazette this week that the house is in the last stages of obtaining state licensing, and already has three pregnant women waiting to start treatment.
Billings Gazette reporter Phoebe Tollefson presented the empty bed/waiting list dilemma in a front-page story on Saturday. Unfortunately, nothing has changed since an Aug. 7 Gazette opinion called for Congress to end this counter-productive rule.
U.S. Sen. Jon Tester is a co-sponsor of S. 1169 that would abolish the 16-bed rule. The bill was introduced by a Democrat, but its 15 cosponsors include Republicans. In the House, HR 2931, the Road to Recovery Act, would also remove this arbitrary size restriction. Rep. Greg Gianforte isn’t among the 36 Republicans and Democrats cosponsoring this bill introduced by a Pennsylvania Republican. Gianforte and Sen. Steve Daines should cosponsor these bills and do all they can to move the legislation forward.
When President Donald Trump declared a public health emergency last month, he called for the federal government to fast track state applications to be exempt from the 16-bed rule. But so far, only five states have the waiver.
Montana Department of Public Health and Human Services is just beginning to discuss seeking a waiver of the federal rule, according to a department spokesman.
It’s unclear how long that process would take, but most federal program waivers are time-consuming tasks for state workers. Leaders of Montana DPHHS have had to focus on budget cuts for the past several months and there is no end in sight for state spending reductions as the Legislature convenes in special session.
Both DPHHS leadership and the Montana congressional delegation should put top priority on access to substance abuse treatment.
Drug abuse is a root cause of most of the crime and child neglect found in Montana. Recovery is possible, but addicts can’t do it alone.
Getting them into treatment greatly improves the likelihood that they will stay drug free, get jobs, stop committing crimes and take proper care of their kids. Without treatment, addicts are at high risk for re-offending, going back to prison, and leaving their kids in the foster care system. Effective treatment isn’t cheap, but lack of treatment is much more expensive for taxpayers and crime victims.