New coverage pays for drug addiction treatment services like Methadone, but access to detox centers remains limited.
“It’s Dark Thirty out there,” says Tamara Nunez after I follow her into Matrix Institute, a clean but shabby two-story addiction clinic in Mid-City Los Angeles. It’s Five-Thirty A.M. and even though the sun is just coming up, ten patients are already waiting in line. Nunez is dressed in a rainbow blouse ready to start her day.
“I wake up every morning, 5 o’clock my eyes are open and I just come down here, I dose, and I go home for a couple hours,” she says. “I go to work late in the afternoon.”
At the reception window, she recites her 4 digit patient number. She’s buzzed to a nurse’s station, where a computer disburses a liquid dose of medicine: a small cup of the prescription opiate, Methadone.
“It’s working for me. Some people call Methadone just another addicting drug, but it’s what works for me. It’s legal. I’m not in any trouble. I’m not out there on the street trying to get money.”
Nunez, 56, started using heroin 30 years ago. She lost her job, her family, and her house. Now, she’s stable and has been mostly clean for nine years. But she had another problem: No health insurance. She couldn’t afford it and she didn’t qualify for Medi-Cal, the state’s version of the Medicaid program. So she had trouble paying for her Methadone.
“I know that if I didn’t have the Methadone where I’d be: I’d be sticking a needle in my arm, probably getting some disease by now… So Obamacare it helped me a lot.” — Tamara Nunez, 56
That all changed in January when Nunez became eligible for Medi-Cal thanks to the Affordable Care Act. Now her Methadone is covered.
“I know that if I didn’t have the Methadone where I’d be: I’d be sticking a needle in my arm, probably getting some disease by now, so Obamacare it really helped me a lot.”
This increase in addiction treatment is happening statewide. According to health officials, more than 8,000 new patients in California had narcotics treatment covered in May compared to December of last year, before the health care law took effect. Obamacare covers detox and other out-patient services like counseling. Under Obamacare, everyone at or below 138 percent of the federal poverty line qualifies, even adults without children. Some, like Nunez, are working poor. Other addicts who will qualify are behind bars.
On any given day there are between 18,500 and 19,500 inmates detained in Twin Towers and Los Angeles’ other facilities. There are another 50,000 or so people on probation in L.A. County. Of this population, only about 10 percent would have qualified for Medi-Cal coverage before. Now, some estimates put the number closer to 90 percent because of the expanded eligibility.
There are thousands of potential patients at Twin Towers Correctional Facility and the Los Angeles Sheriff’s Department is looking at ways to hook them up with services in order to curb repeat drug offenses.
That’s good for public safety, according to Reaver Bingham, deputy chief of Field Services for the Los Angeles County Department of Probation.
“It’s critically important. One of the things we learn is If there is any gap in time from when an individual is released from custody to their ability to get into any type of program, we could possibly lose that individual and they re-engage themselves in that type of behavior, so what we do in those first few days subsequent to their release is critically important.”
Hoping to enroll some of these people who now qualify, jail officials now have opened eight ticket windows right in the area where released inmates pick up their belongings.
Lt. Xaviar Aguilar showed me around. On one side of the glass windows, sit social workers with the Department of Social Services, Medi-Cal, the Department of Public Health and other agencies. On the other side, stand released inmates. They can get help enrolling in health insurance and find out about drug services before they leave.
But some hurdles remain. Access to detox centers or a detox bed in a hospital are still hard to come by. That part of the system has yet to catch up.
The walk from the downtown jail to Skid Row is short. About a mile and half away is a clinic called Homeless Health Care LA. It has medical offices and a clean needle exchange. Here I meet a couple patients who are still getting used to having health insurance for the first time.
“Who’s got insurance? Kaiser or State Farm — nobody had that being homeless,” says Albert Basie. “Medi-Cal helps.”
Since enrolling in Medi-Cal, Basie says he has visited a primary care doctor and talked about his heroin addiction. But he says he needs in-patient services covered in order to completely kick the habit.
Several other people sit in the busy reception area at Homeless Health Care LA watching a community television. One man is sleeping on a chair in the corner. Staff at the front desk field questions, book appointments, exchange used syringes for clean ones and refer patient to other medical providers.
Jesse Calderon just did ten days in Twin Towers for a parole violation. He has been inquiring at the front desk about detox options, but admits he’s not sure he’s ready for that. Even if he decides to apply for a 21-detox program right away, there’s still a waiting list for referrals.
“The biggest thing we deal with is people who need Detox and all the programs are full,” says Chloe Blaylock, a coordinator at Homeless Health Care L.A. She says problems with reimbursement are still preventing access.
“We see 100 people on a Tuesday or a Thursday and [have] this detox list it’s at least 30 or 40 people a month,” Blaylock says.
Experts say this is an obstacle caused by an obscure federal law that only permits Medicaid to cover treatment at addiction centers with 16 or fewer beds. Most detox centers in California are too large to qualify, with 50 or 100 beds. Changing this will require a lawsuit in the courts or new legislation from Congress.
In the meantime, addicts on probation do have cheaper out-patient services and poor patients at Methadone clinics can now get their Methadone for free. This change comes out of an overarching principle to treat addiction as a chronic disease — not just bad behavior or a crime. And if the health care law works as intended, Americans living in poverty who want to be in recovery have a lot to gain from that new coverage.
This report is part of a project for the California Endowment Health Journalism Fellowship, a program of USC’s Annenberg School for Journalism and Communication. Read and listen to part 2 of the series: How Obamacare is changing rehab.