No Beds Left: Federal Laws Stand In The Way Of Drug Treatment

Oct 3, 2018

Jacqueline Abney lives in the Beacon House, a residential treatment center that looks just like any other home you would see in the historic downtown area of Wooster. The only difference: Jacqueline is living with several other women struggling with substance abuse disorder.

“It didn’t seem like it was an institution,” she says. “And that’s what I was really scared of. It was homey and I thought, “O.K., I might be able to handle that.’”

Abney had been fighting an addiction to heroin, which evolved into an addiction to meth, for seven years – until one day, she lost her job.

“My life was very unmanageable,” Abney says.” I was losing everything. I lost houses, my car, my kids, the respect of my peers at work.”

Losing her job was the catalyst that convinced Abney to make a change.

“So I thought, enough is enough, you’re 40, let’s do something,” Abney says. “So I called up here.”

She emphasizes just how important that first phone call can be for person struggling with addiction.

“They call that the 900-pound phone,” she says. “You know the help’s there and you know the help could be there, but to actually pick it up and do it is probably the biggest and first step to recovery, I think.”

When it comes to connecting people with a substance abuse disorder to care, many barriers remain. Ohio’s opioid epidemic has shined a spotlight on several policies that may have served a purpose in the past but, to many advocates, only stand in the way of treatment now.

Mental health and addiction experts agree with Abney, that picking up the phone and making that first phone call is vital for anyone seeking treatment. There’s no shortage of phone calls here at the OneEighty crisis center, which runs the Beacon House.

But OneEighty executive director Bobbi Douglas says many facilities in Ohio and around the country are running into a major challenge.

“The federal government actually restricts residential treatment centers from being able to have no more than 16 beds, and sometimes communities need more than 16 beds,” Douglas says.

The bed limit is known as the Institutions for Mental Diseases exclusion, or the IMD Rule. It says the federal government can’t issue Medicaid funding for any facility with more than 16 beds, a rule meant to discourage money for large mental health institutions.

But the exclusion has unintended consequence, forcing centers to turn people away because they’ve reached capacity. Douglas says there’s a sense of urgency when it comes to connecting people with treatment right away.

“What we want to do is remove the barriers so we can get people into a place where hopefully they can start to see that there’s a different way, and then they become motivated for themselves in terms of wanting to get better,” Douglas says.

Sen. Rob Portman (R-Ohio) agrees with that sense of urgency.

“There are so many heartbreaking stories of people who are ready for treatment, they go to a treatment center to find out that there’s a wait, during that interim period they continue to use, and in a couple of cases specific to Ohio those individuals have overdosed and died,” Portman says.

Portman is seeking a measure that would either raise the bed limit to 40 beds or get rid of the cap altogether. But there’s a dilemma – that kind of bed limit increase can hike Medicaid costs by as much as $10 billion.

Portman says he’s working on a plan that could bring that price tag down to around $2 billion, and along with Sen. Sherrod Brown (D-Ohio), he’s making his pitch to Congress.

“I say we’ve got to do something now before this issue gets even worse,” Portman says. “We’re losing more people every year to opioid overdoses than any other single cause in Ohio.”

The bipartisan proposal, part of a larger bill addressing opioid addiction and treatment, gets rid of the Institutions for Mental Disease exclusion entirely. It would eliminate the 16-bed rule for five years, giving Congress a chance to examine how much it might increase costs before making a permanent change.

The bill passed the U.S. House and awaits a vote in the U.S. Senate.

“This is a really pivotal moment in the behavioral health field and our ability to respond appropriately as communities to people recovering from addiction and managing their mental health recovery as well,” says Lori Criss with the Ohio Council of Behavioral Health and Family Service Providers.

Douglas supports raising the bed limit and says there’s a way to rein in costs even with an increase.

“There’s an economy of scale that comes so you can provide more treatment to people at a lower cost,” Douglas says.

Gov. John Kasich and his administration has also recognized the problem with bed limits. In fact, his office has put out a letter stating that the rule should not be applied to residential centers such as the Beacon House.

A change on the federal level would create more stability for treatment centers trying to follow the rule, especially considering Kasich is term limited and the next governor may view the rule differently.

Meanwhile, Abney is 21 days sober at the Beacon House.

“For the first time, like, I see the light,” Abney says. “I don’t just say, ‘Oh, there’s a light at the end of the tunnel,’ like I really see this light, so it’s amazing.”

And she’s grateful there was a bed ready for her when she decided to pick up the phone and call for help.