By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
But both agencies became obsolete on July 1, when Magellan and Value Options took over the job of referring patients to the centers. Since then, the number of clients getting into treatment has steadily declined, says Homeward Bound's Douglas Denton.
Homeward Bound is the county's largest residential treatment program for adults, but even its size hasn't protected it from the cuts. "We have had to cut in half the women's residential program because we can't afford to staff it and wait," Denton says.
To its credit, the state has tried to correct the problem by giving the Greater Dallas Council more money to resume its role as a referral agency, while Magellan and Value Options are compensating the centers' early losses by advancing them payments.
This adjustment may help some places survive the transition into managed care, but even those that do will find the length of their treatment curtailed. As a result, they will have to either cut back their programs or provide the care by asking private donors and Dallas County to bail them out.
Both Matyas and Waters confirm that their companies are scaling back residential drug treatment services because of their costs. For his part, Waters says the cuts are necessary because they are the only way he can live up to the state's requirement that he expand the number of people covered under Northstar.
"By lowering lengths of stay, you create increased capacity," Waters says. "For chemical dependency, a lot of the research shows that you can be just as effective with a program that has a reduced length of stay for residential [treatment] and an expanded outpatient program."
But chemical-dependency counselors object to the notion that their residential programs are too long, pointing out that they were designed in accordance with state guidelines that have been steadily cut over the years because of funding constraints.
"There is a direct correlation between length of stay and recovery. The longer you stay, the better your chances are for getting healthy," says Daytop's Cinisomo. "Nobody wants me to discharge kids because I ran out of money. That's morally reprehensible. God forbid it was one of these people's kids -- how long would the length of stay be then?"
Even if it were true that the residential programs were too long, the counselors say they are not seeing a corresponding increase in the length of time patients are getting approved for outpatient treatment. Instead, that time is also being cut.
In fact, it was a reduction in outpatient services that undid New Place, says Tartaro, who saw the number of hours for outpatient treatment per patient cut in half under Northstar. "We were in a kind of Catch-22," she says. "We would have to have twice as many clients to make the same money we made before, which increases staff and increases expenses."
At Homeward Bound, Denton says the situation is exacerbated because the companies' reimbursement rates are lower than what the state used to pay under his old contract with TCADA. When you add those losses to the new administrative costs associated with getting authorization for care, Denton says, Northstar equates to a financial crisis that he may not survive. But he doesn't blame the companies for this.
"Truly Northstar is a work of art on the part of the managed-care companies to provide services. It can be a beautiful project if it's done correctly and the rules are followed," Denton says. "But once you start looking at the numbers, you see it's a grossly underfunded project."
If the state doesn't take steps to reverse the current financial strain, Daytop's Cinisomo says, anyone wondering what the future holds for kids should think about Plano. If the number of kids dying of heroin overdoses looks high now, he says, they should just wait.
In September, Cinisomo laid off six counselors in an effort to offset his losses. Despite the cuts, Daytop is some $230,000 in debt, a situation that has prompted its New York-based board of directors to consider closing its Texas operations.
Like New Place, Daytop works closely with the criminal court system, and its potential demise would blast a major hole in Dallas County's efforts to prevent juvenile offenders from becoming career criminals. The center is one of only three programs that Dallas County's juvenile-services department relies on to treat kids who wind up in detention because of their abuse of drugs and alcohol.
"Three of these programs wasn't enough. If we lose one, then it's gonna be a concern," says Mike Griffiths, the department's director.
Since Northstar began, Griffiths says, the companies will only authorize up to two months of treatment, down from the traditional six months, for kids who wind up in detention because of their addiction. Worse, some kids who sit in detention for up to three weeks while waiting for a judge to order them into treatment are getting denied coverage altogether.
"The plans say, 'Well, he's not medically eligible anymore because he's been sober for three weeks,'" Griffiths says.
While Cinisomo is having to cut costs and beg for more donations to make ends meet, Griffiths is paying his bills by spending money earmarked for other juvenile programs. Unless the plans change their authorization policies, Griffiths says, he'll be forced to go before the Dallas County Commissioner's Court to request a budget increase.