New Medicaid Model for Behavioral Health, Addiction Intervention
Bryan Cote
In 2010, I cofounded the Migrant Family Health Network (MFHN), an organization to assist refugee parents and adolescents in the Hartford, Conn., area. The main goal was to help teenage girls, many of whom were taking on roles as de facto heads of household for their first-generation parents.
Economic and cultural challenges were enormous. Addiction to drugs and alcohol and other behaviors, namely eating disorders, were common. And in nearly every situation, the mother or father or teen relapsed in the first years of the family’s time here in the states because of a failure to either prevent the crisis or manage the transition from crisis to treatment. Hospital emergency departments, physicians, employers, schools and counselors weren’t positioned to do much more than triage.
So we’ve tried, through a network of more than 200 volunteers, to provide a solution, assigning each of these individuals a single advocate, like a case worker, untrained in healthcare but willing to provide a support system to one person—one family—through the challenges of life, and in some cases the crisis toward recovery. All advocates are volunteers, and all MFHN services are free.
In 2018, six of the 236 individuals made it through outpatient addiction treatment, paid for in part by Connecticut’s Husky Health Medicaid program. Each one is working again and being monitored by their volunteer advocate. In several cases, skills these adults developed in their home countries have been put to use in jobs here, like carpentry to help a construction company build houses. These are remarkable numbers when you consider that in the past 10 years, three refugees in this community, including one teen, died from complications related to addiction.
How managed Medicaid plans use and pay for creative case management like this will be interesting to monitor as more states shift Medicaid recipients into managed care and as the cost of healthcare and addiction rise. The evolution of cancer treatment and coverage could be instructive. In 2005, many payers did not pay for much of the case management and social service work by cancer care providers, but by 2012, many had begun to reimburse for these services.
Let’s hope we see a similar evolution in addiction care.