Closing this vital treatment facility is a crisis for Pierce County. Where’s the concern?
This should be a bigger deal. It should be something people are talking about. There should be outrage, and even condemnation.
There should have been alarm bells, and there most certainly should be a plan.
Late last week, The News Tribune’s Josephine Peterson reported on Metropolitan Development Council’s decision to close its downtown detox center. It’s been shuttered. Since January.
What that means is as cold and straightforward as it gets: Until it reopens, most people from Pierce County who are on Medicaid, Medicare or the state’s free or low-cost Apple Health plan can’t take what’s often the first step of drug and alcohol treatment — at least in the county they call home.
Let me say that again, in slightly different words, because it’s that important. In a county of nearly 1 million people — more than 230,000 of which are Medicaid recipients — it’s now exceedingly difficult for a person living at or near poverty to begin the process of recovery locally. In order to enter rehab, in many cases — including with alcohol dependency — you have to go through medically supervised detox first. In Pierce County, that’s a resource that no longer exists for far too many people.
There’s simply no way it should have come to this, and no way as a county that we should have let it happen.
Think about it: We talk endlessly about how people need treatment, and how it has to be available. We talk about homelessness, crime and all the other problems that addiction has its tendrils around. We argue, we spit and we fight, but one thing we seem to agree on is that people who want help kicking drugs and alcohol should be able to get it, and encouraged to do so.
The truth?
Apparently, we lied. We had our fingers crossed behind our backs the whole time. We didn’t mean it.
The issue at MDC — like so many service providers — appears to involve money. Since 2019 Pierce County has relied on a handful of managed care organizations (MCOs) to administer Medicaid funds for behavioral health services, including addiction treatment. Prior to this change, Optum Behavioral Health managed most state-funded behavioral health services in the region. In the old days, Optum would pay a provider like MDC for its 16 detox beds regardless of whether they were occupied. Under the new way of doing things, the MCOs only pay if there’s a real, live person sleeping in them.
In some ways that’s a fiscally reasonable approach, but there’s a glaring problem. When beds aren’t occupied - as has been the case at MDC since the pandemic hit, for complicated reasons, none of which involve an actual reduction in their necessity - the money dries up.
As agency spokesperson Rob Huff told The News Tribune, it’s a matter of “sustainability.”
“We were struggling to have the detox full every day,” Huff told The News Tribune. “So we are trying to get at the heart of that, and we want to bring back the service where we are all full every night.”
While it’s currently unknown how long the program will be suspended, on its website MDC says it’s planning to begin accepting new patients during the second quarter of 2022. Here’s hoping.
Until then, there’s blame to go around for the dire situation Pierce County now finds itself in.
A big part of the problem is making essential services like drug and alcohol detox dependent on meagerly rationed state insurance funding, which is backwards and speaks poorly of our priorities as a society. But it’s also fair to wonder if the agency — which has been led by interim President and CEO Mieko Gray since Pamela Duncan’s departure last year— could have found a way to hold on. At the very least, it sure seems like the community and other service providers who depended on MDC’s detox beds should have been warned of the possibility a long time before it came to this, and been provided an opportunity to find an alternative. The news came as a shock to far too many.
Then there’s the larger picture, and the county and city governments who so often talk about helping those in need — and relied on MDC’s detox beds to do it. They also deserve tough questions. To date, none have responded in any meaningful way. There have been no vocal calls to action from local elected officials, and no plan to fill the void. Whether it’s MDC operating detox beds in Pierce County or a more stable organization, the outright loss of a critical service should be cause for grave concern. Clearly, it hasn’t been.
That’s unacceptable, particularly given the stakes.
All of this talk of bureaucracy and inaction takes us back to the reality now facing people in Pierce County who desperately need help overcoming addiction.
Even when MDC’s detox center was operational, taking the first step in recovery was far from pleasant. Unlike the accouterments available to those with fancier insurance plans, there was no ice cream, no soft blankets, no soft lighting. Checking into detox meant getting a ride downtown, standing on a cold front door stoop and repeating your name through a fuzzy call box until someone let you in. You had to want to be there.
Now? Even that option doesn’t exist.
At best, drug and alcohol treatment for Pierce County residents on Medicaid or state insurance involves getting lucky, finding a detox bed somewhere else and traveling to another county — in some cases as far as Port Angeles.
At worst, it means not getting treatment at all.
This story was originally published March 28, 2022 at 5:00 AM.
