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The current crisis of substance use disorders demands federal and state policy responses: Brian Lane and Daniel Lettenberger-Klein

CLEVELAND – The substance use disorder crisis in our region and across the country is not going away. In fact, it’s getting worse and worse. Ohio State is ground zero for opioid overdose deaths, leading the nation with an overdose death rate of 38.3 per 100,000, compared to 21.6 per 100,000 nationally. And it’s not just about opioids anymore. The crisis has deepened and evolved. We are now in the fourth wave of the epidemic characterized by the simultaneous abuse of stimulants and synthetic opioids.

Here in Cuyahoga County, the numbers are even more staggering. Overdoses of mixtures of cocaine and fentanyl are up 85% in 2021 compared to 2020, according to calculations from the July 12 medical examiner’s draft mid-year update report on “deaths related to heroin/fentanyl/cocaine in Cuyahoga County”.

We need to start thinking about how we can increase access to care so people can get treatment. Addressing this crisis effectively requires re-examining and revamping Medicaid reimbursement rates, as well as addressing the mental health workforce shortage – ensuring that all Ohioans have access to the care they need. so much need.

First, our Medicaid reimbursement rates are woefully inadequate and out of step with the rates paid by private payers. This, in turn, leaves our most vulnerable populations at risk as they face significant barriers to accessing care. Rising inflation, coupled with these below-market rates, has only exacerbated this long-standing problem. Policy makers should review these rates and adjust them to reflect market demand.

Although there was a 2018 Ohio Medicaid behavioral health overhaul, some of these rates, when re-examined, actually resulted in lower rates than in 1999, the last time they have been revised. And surprisingly, reimbursement rates for 24-hour residential care are lower than those for day-use outpatient care.

Brian Lane is the president and CEO of the Cleveland Center for Health Affairs.

Although cost-effective treatment is a necessity, providers who work diligently to properly assess and place clients into specific levels of care should be fairly compensated. This current reimbursement model creates the possibility that clients do not receive proper placement and care during the continuum, which could ultimately lead to less successful long-term outcomes, such as relapse and overdose. This trend is not only unacceptable, it cannot be sustained if we are to treat substance use disorders and help those who need it most.

Additionally, as depression and anxiety have increased dramatically during the pandemic, we have fewer and fewer mental health professionals to treat those in need of treatment. The help of policy makers is needed to address the challenges of the health workforce in general, and in particular in the field of mental health, where shortages are glaring. Meaningful legislation that incentivizes both the recruitment and retention of these professionals must be enacted at the state and federal level. And while measures like loan forgiveness can help bring in new workers into mental health care, we also need to look at ways to keep the workers we have by tackling staff burnout and fostering worker resilience. Subsidies, released by the government, can and have ameliorated some of these challenges, but they must continue, and with increased frequency.

Daniel Lettenberger Klein

Daniel Lettenberger Klein

In summary, while Ohio currently leads the nation in opioid overdose deaths, Ohio also has an opportunity to lead the nation in addressing this crisis by enacting meaningful reforms to the structure of Medicaid reimbursement, which could then be replicated nationwide. This would provide greater parity and access to critical substance use disorder services and position Ohio as a national model for reform while embracing a policy framework that stimulates talent and resources in the field of mental health care.

Brian Lane is President and CEO of the Center for Health Affairs, the voice of Northeast Ohio hospitals for more than 100 years. Daniel Lettenberger-Klein is CEO of Stella Maris, Ohio’s oldest treatment center, which has provided transformational addiction and mental health treatment services to the people of Greater Cleveland since 1948.

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