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BOSTON (State House News Service) — As opioid overdose deaths remain high across the state, substance abuse treatment providers say that increasing reimbursement rates for Medicaid patients may be necessary to avoid closing available beds at addiction and recovery facilities.
MassHealth and the Executive Office of Health and Human Services are considering a score of rate changes, increasing how much providers are reimbursed when they admit a patient with Medicaid insurance for addiction treatment.
Providers are reimbursed for Medicaid patients at rates 50 percent below what they are paid on average by commercial insurers, said David Matteodo, director of the Massachusetts Association of Behavioral Health Systems, at a hearing on the rate change Monday.
"Our providers really want to treat MassHealth. But we simply cannot continue to do it with a rate that's not viable," Matteodo said.
Richard Curcuru, president and CEO of Cape Cod-based addiction center Gosnold, said his facility does not want to turn away Medicaid patients, but that they may need to close services in order to continue to treat them.
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In 2016, 65 percent of Gosnold's patients had commercial insurance and 35 percent used MassHealth, Curcuru said. Since then, commercial admissions have declined year after year, and in 2023 commercial payers represent about 20 percent of patients, compared to 80 percent on Medicaid.
"Even though the Medicaid rate was not sufficient back then, reimbursement from the commercial payers covered the shortfall we had on our Medicaid patients," he said. "Currently, our expenses for detox exceed the Medicaid reimbursement. This means that there is a significant loss to the organization for every Medicaid patient we admit. This is obviously not sustainable."
Written by Sam Drysdale/SHNS.
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