Crisis of Access: How to Insure Treatment for Addiction Among Baltimore’s Poor in the Age of Managed Care

March 1999 / Abell Reports / Criminal Justice and Addiction, Health and Human Services

After one full year of managed care, there are 29% fewer in treatment.

Even though experts agree that drug addiction is the primary cause of crime in Baltimore, access to addiction treatment declined in Baltimore in l998 as a result of a single dramatic change in the health care system: the introduction of mandatory Medicaid managed care. In July, 1997, more than 300,000 Medicaid participants in Maryland entered the brave new world of managed care. This broad structural reform was intended to reduce the costs of health services while improving the health of participants. Its administrative complications, however, had the unintended consequence of reducing the availability of addiction services for thousands of Baltimoreans at the same time Mayor Kurt Schmoke is trying to provide treatment on demand.

Managed care advocates contend that it reduces costs and improves health by decreasing the use of acute care services, and by coordinating preventive, primary, and specialty care. The extent to which these goals are being met by the Medicaid managed care program in Maryland for patients in need of addiction treatment is in serious dispute.

Data provided by the Maryland Department of Health and Mental Hygiene in November, 1998 for this report, show that Baltimore City addiction treatment providers served 29% fewer Medicaid beneficiaries when comparing fiscal year 1997 (i.e. the year prior to implementation of the Medicaid waiver) to fiscal year 1998. If this decline in the availability of addiction services is accurate, it poses a danger to the quality of life for
all Baltimoreans.