Providers of addiction services are facing two public-health emergencies at once: substance-use disorders and the COVID-19 pandemic.
But advocates argue that addiction-treatment and -recovery organizations have not received much support from Congress, even after lawmakers allocated trillions of dollars to the coronavirus response.
An array of behavioral-health groups are pressing Congress to include a $38.5 billion investment in the next round of funding to support mental-health and substance-use-disorder providers.
“Investment in mental health through this Congress, especially in the time of COVID, has been almost an afterthought,” said Benjamin Miller, chief strategy officer for Well Being Trust, which advocates policies and programs to address mental illness and substance abuse.
“The underlying mental-health epidemic in this country was really bad before COVID,” Miller said. “I can’t imagine, without some type of profound and robust investment in intervention, it’s going to be any better after COVID.”
The Substance Abuse and Mental Health Services Administration received a total of $425 million in the $2 trillion coronavirus package that passed in March. This included $250 million for a community behavioral-health grant program, $50 million for suicide-prevention programs, $100 million for mental-health and substance-abuse emergency grants, and $15 million to tribes and various health organizations that serve American Indian populations.
But the investment in SAMHSA is not nearly enough to help behavioral-health organizations cover their costs, including the expense of purchasing personal protective equipment, said Yngvild Olsen, vice president of the American Society of Addiction Medicine, which represents addiction-treatment providers.
“These are kind of the costs that behavioral-health providers across the country are facing," Olsen said. "And without very directed, robust funding that is dedicated to addiction and mental-health providers, the relatively small amount that has come through SAMHSA is really just a drop in the bucket.
“I think there are many many providers that are extremely worried about being able to keep their doors open,” she added.
The American Society of Addiction Medicine and the National Council for Behavioral Health wrote to congressional leaders in early April pressing for an infusion of $38.5 billion in emergency funding for behavioral-health organizations “to avert a large-scale public health calamity.”
In mid-April, the National Council released results of a survey showing that 62 percent of community behavioral-health organizations expect they can financially survive for only three months or less during the COVID-19 pandemic.
Congress has dedicated billions in emergency funding to hospitals and health care providers. An emergency fund for hospitals and providers received $100 billion from the $2 trillion legislative package in March, and another $75 billion was added in follow-up legislation. But many addiction service providers may not be eligible for this money.
“As far as I can tell, so far, none of the money that has been set aside specifically for health care providers is necessarily going to addiction treatment organizations, which is very concerning,” said Charles Ingoglia, president and CEO of the National Council, which advocates for organizations that provide mental-health and addiction services.
A bipartisan group of lawmakers, including Sens. Debbie Stabenow and John Cornyn, have also expressed concern that the hospital funding will not adequately support mental-health and substance-use-disorder services, citing concerns with the Health and Human Services Department's disbursement of the money.
The department released $50 billion of this funding to Medicare providers, but advocates pointed out that Medicare is not the biggest payer of addiction services. Medicaid is the biggest payer for mental-health services and is playing a large role in substance-use-disorder treatment coverage.
“We are concerned that this approach may continue to significantly underfund and potentially continue to exclude many essential providers, including mental health and substance use disorder treatment providers who serve a large number of Medicaid beneficiaries,” the senators wrote in a May 4 letter to HHS Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.
Advocates are making the push for more financial support at the federal level as some states are weighing broad spending cuts. New York, for example, is facing a $13.3 billion shortfall in revenue in the upcoming fiscal year and is expected to lose $243 billion over the course of recovery from the COVID-19 pandemic.
Substance-abuse program budgets could end up on the chopping block, along with several other programs that provide community support. In a financial plan released April 25, New York officials included $8.2 billion in cuts to “aid-to-localities” spending, which includes funding for substance-abuse programs, special education, children’s health insurance, and residential services for vulnerable populations.
“They’re talking about a 20 or 30 percent cut to community-based organizations, maybe even 40 percent,” said John Coppola, executive director of the New York Association of Alcoholism and Substance Abuse Providers. “It scares the daylights out of folks. … If you even do a 5 percent cut in some programs, they’ll be closing their doors within days, not months.”
Coppola said that a federal investment of $38.5 billion could go a long way in helping these organizations stay afloat.
“We have a behavioral-health infrastructure which is on the cusp of collapse because of fiscal-viability issues,” he said. “Now, I’m sure that Congress doesn’t want to talk about its failure to adequately support mental-health and addiction programs. But what we say is, we’ve got an escalation to the point where we’re talking about a suicide epidemic. We’ve got the escalation of mental-health and addiction issues directly related to coronavirus, and we had a problem before that.
“We have a situation where we have really failed to keep pace with the funding needs of these organizations, so it’s a dire financial circumstance at a time when we need these people the most,” he added.