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

Dan Konik
Beacon House in Wooster, OH

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

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

Jacqueline is living in the Beacon House. This residential treatment center 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. And that’s what I was really scared of, it was homey and I thought ‘ok’ I might be able to handle that,” Jacqueline says.

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

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

She emphasizes just how important that first phone call can be for an addict.

“They call that the 900-pound phone. You know the helps 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,” she says.

There’s no shortage of phone calls here at the OneEighty crisis center, which runs the Beacon House.

Mental health and addiction experts agree with Jacqueline, that picking up the phone and making that first phone call is vital for anyone seeking treatment. But OneEighty’s 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. It’s meant to discourage money for large mental health institutions.

However, it’s having what some see as an unintended consequence, forcing centers to turn addicts 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,” says Douglas.

U.S. Senator Rob Portman (R-Ohio) agrees with that sense of urgency when it comes to connecting people with treatment.

“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,” says Portman.

He’s 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 up Medicaid costs by as much as $10 billion.

Portman says he’s working a plan that could bring that price tag down to around $2 billion, and he’s making his pitch to the U.S. Senate and U.S. House.

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

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,” says Douglas.

Gov. John Kasich (R-Ohio) 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.

As for Jacqueline Abney at the Beacon House, she’s 21 days sober.

“For the first time like I see the light 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.

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