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Published: Sunday, 6/29/2014


Risky budget

Money shifts and accounting changes won’t fill the state’s enormous gaps in treating heroin and opioid addiction

State budget changes are squeezing local mental health and drug addiction boards, as Ohio grapples with a crisis in opioid and heroin addiction. Even with Ohio’s prudent Medicaid expansion, changes included in new budget legislation will cost local boards, and the community agencies they fund, millions of dollars.

Many measures in the budget legislation Gov. John Kasich signed this month will improve access to drug treatment in Ohio. Most important, they provide some uniform standards for counties, including medication-assisted treatment, residential care, and peer mentoring.

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Such standards, largely the result of advocacy by state Rep. Robert Sprague (R., Findlay), will fill important service gaps. That’s especially true in rural counties, which have been hard hit by the state’s opioid and heroin epidemic but lack resources to fight it.

Other budget changes, however, could stretch treatment resources even thinner. The budget still falls far short of adequately treating heroin and other opioid addiction, even as drug overdoses continue to soar. Local boards were already getting $140 million less in state aid than they were a decade ago.

Opioid treatment programs in Ohio, which serve 30,000 people a year, reach as few as one in 10 of those who need them. Waiting lists and delays discourage many users from seeking help. Shifting money around and making accounting changes won’t fill the state’s enormous treatment gaps.

Changes in how the state funnels federal money to local communities to treat addiction could cost local boards as much as $20 million next year. A plan to distribute $63 million in federal money over 18 months instead of a year is meant to alleviate cash-flow problems, which have left many addiction service providers hard-pressed to meet payroll costs.

But this “realignment” will leave local boards short next year. Scott Sylak, executive director of the Mental Health and Recovery Services Board of Lucas County, told The Blade’s editorial page that the plan will cost Lucas County roughly $900,000 in block grant money for substance abuse prevention and treatment.

The budget legislation also effectively redirects money from local mental health and drug treatment boards to the state for drug-addiction initiatives across Ohio. The state Department of Mental Health and Addiction Services argues that the bill provides $47.5 million more for community-based addiction programs, including housing assistance and residential treatment.

But local boards say the money comes largely at their expense. Lucas County expects to lose $2.3 million to $3.1 million in such state funding next year. Other boards statewide will suffer even more. Lucas County receives $17.3 million a year from local levies — most of the board’s $27 million annual budget.

Lucas County aims to get clients into treatment within seven days, Mr. Sylak said. But local treatment providers frequently don’t meet that standard, even though access to treatment in Lucas County exceeds the Ohio average. “There’s simply not enough capacity in the system,” Mr. Sylak said.

For heroin and other opiate addicts, even short delays can mean the difference between relapse and recovery — and life and death.

Thanks to a levy that county voters approved in 2012, Mr. Sylak does not expect significant effects on Lucas County clients next year. What happens to treatment programs after that, however, is less certain. The board funds 21 agencies.

The new budget changes also give the state more control over local programs — a move that has potential benefits and liabilities. It takes away some local control, but ensures that more-adequate treatment options, including medication-assisted treatment, are available statewide.

Also affecting Ohio’s budget for treatment and mental-health services is the state’s Medicaid expansion, which is expected to pump $550 million into the behavioral health system. That will free up money for county services by providing health care to uninsured mentally ill and addicted Ohioans. Even so, local boards don’t yet know how much they will save.

Budget problems have pitted the state’s mental-health and addiction advocates against each other. That’s not the answer. Both need more resources, as Governor Kasich’s administration concedes.

Ohio’s heroin and opioid epidemic has become a public health crisis, a statewide emergency. Shifting and redirecting money among agencies, boards, and counties won’t solve the problem. If Mr. Kasich and state lawmakers hope to manage this epidemic, they must spend more to expand effective treatment.

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