Medicaid Gap Means Uninsured Texans Face a Tough Road to Drug, Mental Health Treatment
Thousands of Texans would have qualified for Medicaid if state lawmakers expanded the program under the Affordable Care Act. A recent report from the Obama administration finds 23 percent of those in that gap are dealing with a mental illness or substance abuse disorder. Without Medicaid, they have fewer options when they are looking for treatment.
Scott Lynch works at a treatment center called Austin Recovery. A big part of his job involves helping people get into rehab programs, even if that means sending them to other facilities.
Sometimes that involves making sure people get medical or psychiatric help before entering treatment. But the cost of rehab programs is often the biggest barrier people face. Lynch said a lot of people who turn to Austin Recovery don’t have health insurance.
“The large majority of our population is uninsured,” Lynch said. He estimates that 85 percent of the people who call into Austin Recovery seeking treatment are uninsured. Without insurance, or donations from elsewhere, they will likely have to find a way to pay out-of-pocket for treatment.
Trent Thompson had recently been looking for a rehab program here in Austin. He said when he would call a facility, the conversation would go something like this:
“They are like, ‘Can you pay this?’ And I’m like, ‘Man, look. I’m a drug addict. I’m actively using. I don’t have a bank account built up anymore. There’s nothing there.’ And that’s what I’ve experienced.”
Thompson said he found that some facilities almost exclusively take patients that have insurance.
“You are pretty much not going to be able to get in, and that’s where you are getting pretty extensive recovery. I mean like some really good recovery. But if you don’t have insurance you are not going to get in,” Lynch said.
Thompson had made a lot of calls trying to find a way into treatment. He was on a mission to get clean, he said, because he’d been in this place before. He’s been using since he was in high school with periods of sobriety throughout. He’s also had periods of his life where his heroin addiction completely took over. So, when he recently relapsed after 8 months of sobriety, he knew he needed to make this happen.
“I need to get into treatment. I know I have to do this. I’ve kind of messed up in the past three weeks, but it’s just I’ve gotten to – I know how low it gets," he said. "It tears me out and it just starts to eat away at things in my life, and I just know I need to go.”
Thompson said that finally, he was just a few days from getting into rehab. He said he’d talked to a friend who recommended a place that was able to reserve Thompson a spot. But he said the waiting had him on edge.
“They immediately said ‘Okay, we have a bed, and you’ve got to wait a week.’ Sometimes that’s hard because sometimes you don’t know where you are going to be in a week. When you are in active addiction, it’s just like you don’t really have a choice. It doesn’t matter that it’s driving you crazy and it just keeps eating away at you, you don’t really have a choice.”
These wait times aren’t just stressing out people who are seeking help. Lynch said the demand out there is something he deals with all the time.
“Whenever you think you are making headway and covering some ground, you realize that you’ve barely touched a fraction of the people that are in need," he said. "So, definitely the services are underwhelming as opposed to the need.”
Austin Recovery is among a small group of treatment centers that works to provide services to mostly low-income people, but they can only do so much. Their in-patient facility, for example, can only take in about 70 people at a time. And with the rising number of people addicted to opiates like painkillers and heroin, the need is only getting bigger. Austin Recovery’s executive director Ivana Grahovac said that Texas needs more programs like hers.
“The number one issue that is affecting Americans right now is accidental drug overdose. It is now the number one cause of death in America – it has superseded car accidents," Grahovac said. "So, it’s crucial that there are providers like Austin Recovery who can provide affordable, easy access to effective treatment of appropriate duration and intensity.”
A federal report found that, just in Texas, about 406,000 adults who would qualify for Medicaid under an expanded program are struggling with mental illness or substance use disorder. State lawmakers in Texas are still largely opposed, though, to expanding Medicaid.