Unused dollars can be rolled over into additional years. Congress has also approved another $1 billion to be spent nationally through 2021.
Tracking public spending is a key task of the Dayton Daily News initiative, The Path Forward, which seeks solutions to some of the region’s most pressing problems. The addiction crisis is one of the three main topics the newspaper has targeted as problems that are hurting the region’s prosperity.
The analysis of Cures Act spending was done by The Associated Press, which found states are taking very different approaches toward using the money.
To a large extent, the differences depend on whether states participated in Medicaid expansion or not, according to data collected by the AP.
States that expanded Medicaid under President Barack Obama’s health care overhaul, such as Ohio, reported spending their allocations more slowly than states that didn’t expand the health insurance program, the study showed. That’s largely because expanded Medicaid already covers addiction treatment for nearly everyone who is poor and needs it.
The Path Forward: Addiction in Dayton
Gov. John Kasich pushed for the Medicaid expansion to help address the health needs of the poor. The plan went into effect in 2014.
The AP’s data shows 76.5 percent of Ohio’s Cures Act spending went toward treatment, 19.8 percent funded prevention efforts and just 1 percent was aimed at recovery supports following treatment.
However, the Ohio Department of Mental Health & Addiction Services, which is in charge of distributing Ohio's funds, told the Daily News that it purposefully did not distinguish between funding for treatment services and recovery support services in its reporting.
“Patients do not experience services as either treatment or recovery supports but instead as a continuum of care that supports their recovery,” said Ellen Augspurger, project director. “We reported our funding to reflect that approach.”
In total Ohio provided direct treatment and recovery support services to 9,036 patients, according to OMHAS spokesman Eric Wandersleben. Of those patients, 3,163 received recovery supports, according to the department.
The emergency money from Congress was part of a two-year, nearly $1 billion grant program. It was distributed according to a formula favoring states with more overdose deaths and treatment needs. California ranked first with nearly $45 million., followed by Texas with $27.6 million, and Florida with $27.2 million.
In total, states used the money to provide treatment to nearly 119,000 people with opioid addiction, including nearly 3,000 pregnant women, the AP found. More than 33,000 people received recovery services, such as training and housing, according to its analysis.
Among the other findings:
- Every state that did not expand Medicaid allocated at least 58.8 percent of its funding to treatment services. Seven of the states that did expand Medicaid dedicated less to treatment.
- States that did not expand Medicaid spent $2,645 per patient on opioid addiction treatment on average. Expansion states spent $1,581 per patient for treatment.
- States that did not expand Medicaid spent $1,170 per person served on recovery support services. Expansion states spent $446 per person served on recovery.
- States that did not expand Medicaid spent 71 percent of their grant money in the first year. Expansion states spent 59 percent of their grant money on average.
Montgomery County officials say treatment, recovery and prevention are all important in addressing a crisis that has taken the lives of 1,137 people here since 2016.
"You can't have an effective outcome without having all three in place, " said Paula Cosby, director of external affairs for Montgomery County Alcohol, Drug Addiction and Mental Health Services.
Montgomery County has received about $1.2 million in Cures Act money, Cosby said. Addiction programs are also funded through other state and federal grants and through the Human Services Levy.
The county just secured $1.4 million in Comprehensive Addiction Recovery Act grants.
Thirty-three states have expanded Medicaid, receiving enhanced federal funding to cover poor adults. Historically, Medicaid has covered a large share of all addiction treatment in the U.S., more than all private insurance combined. Medicaid covers four out of 10 adults under age 65 with opioid addiction.
Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health, told the AP that Medicaid expansion states had a running start on the opioid crisis, while states without the extra Medicaid funding hastened to catch up.
“Non-expansion states are dealing with populations more likely to be uninsured and more likely to need coverage for addiction treatment,” Saloner said. In contrast, states with Medicaid expansion can use the grants to create new infrastructure, “asking providers to take risks by investing in new personnel, new systems and new ways of doing things. The puzzle is how to keep momentum going after the funds are gone.”
It’s too early to pinpoint whether the spending may be helping solve the crisis, the AP concluded. There are positive signs, however. Fewer people used heroin in 2017 than the previous year, and fewer were misusing or were addicted to prescription opioid painkillers.
The Centers for Disease Control and Prevention has released preliminary figures that also appear to show a leveling off in overdose deaths.
In Montgomery County, which has led the state in overdose deaths per capita for several years, deaths per month dropped in the second half of 2017. In 2018, the county is averaging 22 overdose deaths per month, down from 63 per month in the first half of 2017.
What did local counties spend CURES money on?
Butler County: $660,000
— Expand medically-assisted treatment services.
— Expand coverage of county Quick Response Team and hiring a coordinator.
— Implmentation of Family Drug Court.
— Re-entry program within Butler County Jail.
— Peer support services.
Clark, Greene and Madison counties: $640,000
— Bridge from courts to MAT.
— Warm Hand program for overdose victims in the emergency room.
— Rapid Response Team.
— Safe House for oversdose victims.
Montgomery County: $670,000
— Community based treatment team to provide in-home addiction services.
— 24/7 access for ambulatory withdrawal management.
Preble County: $155,000
— pre and post-natal support for residential treatment for women
Warren and Clinton counties: $430,000
— Suboxone and ambulatory detox services.
— Telemedicine for rural communities.
— Peer supporters, vocational support, transitional and recovery housing.
About the Path Forward
How the region can recover from the addiction crisis is one of the topics the Dayton Daily News is investigating as part of its initiative, The Path Forward, which seeks solutions to the region’s biggest problems.
Next up we will dig deeper into how local counties are spending the millions in state and federal grants to battle the opioid epidemic, take a look at the effectiveness of drug courts, and examine the overload of Ohio’s foster care system that has resulted from the crisis.
Look for Path Forward stories in this newspaper and online at DaytonDailyNews.com/PathForward.
21st Century Cures Act by the numbers
$1 billion Allocated for states to use over two years.
$273.1 million How much states spent in year one.
$26 million Ohio's share each year.
33 states have expanded Medicaid
59.5 % How much of funding states with expanded Medicaid used in year one.
CARLA K. JOHNSON and NICKY FORSTER, of the Associated Press contributed to this report.