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MAT Funding Approaches
Linda J. Frazier, RN, CHES, MA
Treatment Manager
Maine Office of Substance Abuse, DHHS
Maine SSA Context
9 OTP Clinics serving 4,710 clients receiving Methadone
SOTA – State Opiate Treatment Authority History of using Medicaid Funding for
treatment; State Plan includes and supports key components
SSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community
System Change – Ensure Reimbursement for MAT
Legislature approved budget request for $600,000 over biennium to purchase medication,
Continued support of Medicaid for MAT, $100,000 in SFY 08 will be used to increase funds to four pilot agencies and add at least two other pilots This is probably not enough money so we will have to figure out how to further meet the demand
Develop plan for SFY 09 use of $500,000 – explore whether using the state buying power is a better distribution method
Partnership With MAT Agency Pilot Sites
Four original AR MAT pilots and 2 added vivitrol sites. OSA sponsored training to address staff education
and identified barriers of prejudice and ignorance about MAT.
OSA contract specifies that all LOC will not have policies that discriminate against clients prescribed MAT.
Develop treatment processes & protocols – ID need for medication, patients right to have MAT, address internal barriers like staff attitudes.
Challenges
Addiction is a Chronic Health Condition! Getting and keeping money in MAT contracts Preventing Prior Authorization for Medications
for Addiction Treatment Defending MAT budget allocations amidst
state and department wide fiscal cuts Using data results to support the above and
make the business case for sustaining and expanding access to MAT
Suboxone/Subutex Clients as % of MaineCare Total
Total Client Suboxone Clients % Suboxone
2000 153,157
2001 167,076
2002 185,225 1 0.0%
2003 215,549 356 0.2%
2004 225,024 810 0.4%
2005 231,103 1,142 0.5%
2006 231,475 1,799 0.8%
2007 200,091 2,032 1.0%
Suboxone/Subutex Expenditures 2002-2007(YTD)
$-
$500,000.00
$1,000,000.00
$1,500,000.00
$2,000,000.00
$2,500,000.00
$3,000,000.00
MAINE: Percent of admissions with MAT
0%
5%
10%
15%
20%
25%
30%
35%
40%
Baseline (Jan - Jun 06) Jan - Mar 2007 Apr-Jun 2007 Jul - Sep 2007 Oct - Dec 2007 Jan - Mar 2008 Apr-Jun 2008
Percent of admissions with any MAT - AR agencies
Percent of admissions with any MAT - Non AR agencies
Percent of non-methadone admissions with MAT other than methadone
Percent of non-methadone admissions with MAT other than methadone
0%
5%
10%
15%
20%
25%
30%
Baseline (Jan - Jun 06) Jan - Mar 2007 Apr-Jun 2007 Jul - Sep 2007 Oct - Dec 2007 Jan - Mar 2008 Apr-Jun 2008
Percent of non-methadone admissions with MAT other than methadone - AR agencies
Percent of non-methadone admissions with MAT other than methadone - Non AR agencies
Percent of admissions with BuprenorphinePercent of admissions with buprenorphine
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Baseline (Jan - Jun 06) Jan - Mar 2007 Apr-Jun 2007 Jul - Sep 2007 Oct - Dec 2007 Jan - Mar 2008 Apr-Jun 2008
Percent of admissions with buprenorphine - AR agencies
Percent of admissinos with buprenorphine - Non AR agencies
Reduced use at discharge: AR agenciesReduced use at discharge: AR agencies
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Baseline: Jan - Jun 2006 Jan - Jun 2007 Jul - Sep 2007 Oct - Dec 2007 Jan-Mar 2008 Apr-Jun 2008
Reduced use - non-methadone MAT Reduced use - no MAT
Reading Resources
Drug Dependence, A Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation by A. Thomas McLellan et al. JAMA, October 4, 2000, Volume 284, No. 13.
Health Behavior Change: A guide for Practitioners by Stephen Rollnick, Pip Mason, and Chris Butler, Churchill Livingstone, 1999.
Motivational Interviewing: Preparing People for Change, 2nd Edition by William R. Miller and Stephen Rollnick, Guilford Press, 2002.
Addiction and Change: How Addictions Develop and Addicted People Recover by Carlo C. DiClemente, Guilford Press, 2003.
