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When clinics can’t afford to keep detox and rehab beds open, state policy needs to change

Substance use should be treated like other mental health care.

Construction workers participated in a "job site stand down" in the Seaport on April 28 remembering workers who died from addiction and substance use disorder.David L. Ryan/Globe Staff

Officials at MiraVista Behavioral Health Center in Holyoke decided in April to close the center’s 57-bed detoxification and rehabilitation units for people with substance use disorders. Instead, the for-profit center is opening two new psychiatric units.

In a state still in the throes of an opioid crisis, losing dozens of treatment beds is a setback. And the center’s decision underscores the need to adequately fund the facilities that provide badly needed addiction treatment for people who lack private insurance.

In a statement announcing the closure, the organization blamed “inadequate state reimbursement, which falls millions of dollars short of the costs required to operate and sustain programming.” Michael Krupa, founder and former CEO of MiraVista Behavioral Health Center, said in testimony submitted to the Executive Office of Health and Human Services that the substance use units lost $5.7 million dollars last year. The center will move its staff from substance use treatment to psychiatric treatment “where reimbursement rates permit financial viability.”

Indeed, the decision makes financial sense for the center. The managed care plans offered by MassHealth — the state Medicaid program that provides insurance for low-income residents — pay a median reimbursement rate for inpatient psychiatric care of $955 a day. The median rate for hospital-based substance use treatment is $564 a day, according to a report filed with the Legislature by the Executive Office of Health and Human Services. Most substance use treatment occurs in residential detox facilities, not hospitals, which are paid a base rate of $406 a day. There are differences — psychiatric hospitals are locked and require clinicians with a higher level of training — but providers say many of the same patients visit both types of facilities because they have both mental illness and a substance use disorder.


Medicaid rates from neighboring states range from $578 a day for residential detox facilities in New Hampshire to $637 in New York, according to the Association for Behavioral Healthcare.


The Executive Office of Health and Human Services is in the process of reviewing the MassHealth rates. An office spokesperson said MassHealth “is committed to additional substantial rate increases this fiscal year to address the concerns raised by providers due to workforce and other challenges.” The state is expected to propose rate increases ranging from 20 percent to 50 percent, with providers that serve more Medicaid and uninsured patients getting more money.

A substantial rate increase is long overdue. Substance use care is mental health care and should be reimbursed accordingly. As health care facilities face a staffing crisis, Medicaid underpayments make it impossible for treatment facilities that serve mostly poor patients to pay enough to recruit and retain qualified staff. A recent survey of substance use treatment facilities by the Association for Behavioral Healthcare, which represents community-based treatment providers, found that 24 percent of positions were vacant. That leads to bed closures, which jeopardizes access to health care.

Take Charles River Recovery, a Weston addiction treatment center where more than half the patients are covered by Medicaid. CEO Laura Ames said it costs the center $700 to $750 a day to treat a patient. Commercial insurance reimburses between $700 and $1,050. Medicaid pays only $427 per day, even though Medicaid patients are often more complicated to treat.

The financial disincentive to treat Medicaid patients means there are fewer providers willing to do so. State law requires licensed substance use facilities to accept public payers, but the law does not specify how many public pay patients a facility must accept. That leaves treatment centers free to design their services in ways that appeal primarily to private pay clients or those with commercial insurance. For example, a provider does not have to join the insurance network of the major Medicaid plans.


According to the Association for Behavioral Healthcare, since 2019, there have been nearly 600 new substance use treatment beds opened for inpatient detox services but the number of beds available to clients who are low-income or uninsured declined by 136.

Just this April, in addition to the MiraVista closure, Community Healthlink in Worcester suspended admissions to its inpatient substance use programs, closing 131 beds. Beth Israel Lahey Health temporarily suspended service at its 16-bed Danvers Treatment Center due to staffing challenges. Many treatment facilities have waiting lists.

At a recent Health and Human Services hearing on the MassHealth rates, Daniel Mumbauer, president and chief operating officer at High Point Treatment Center, which provides substance use treatment at multiple locations, said in the last three years, the center shrunk from 568 substance use treatment beds to 367 beds, primarily due to staffing. Mumbauer said in order to attract more staff, the center needs more money to provide competitive wages, a good working environment, and retirement benefits.

“We are turning away patients every day seeking addiction treatment,” Mumbauer said.


As long as Massachusetts residents continue to die of opioid overdoses, every person turned away from treatment is a missed opportunity to potentially save a life.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.