PORTLAND (AP) — Maine has directed most of the first wave of federal emergency money to target the opioid crisis on treatment, according to an Associated Press analysis, similar to other states that have not expanded Medicaid.
States are taking very different approaches to spending their initial allotments under the 21st Century Cures Act grant program, according to data the AP obtained through a federal Freedom of Information Act request. Seven states that expanded Medicaid under President Obama’s health overhaul directed less to treatment than non-expansion states, partly because the insurance program already covers addiction treatment.

Maine lawmakers passed Medicaid expansion five times, but Republican Gov. Paul LePage vetoed each effort. Maine voters voted to expand Medicaid last fall, but the governor has blocked it over his fiscal concerns.
Maine was awarded $1.4 million, and spent about $585,000, on treatment and prevention from May 2017 through April 2018. Maine spent no funds on recovery or administration.
The emergency money from Congress was part of a two-year, nearly $1 billion grant program. It was distributed according to a formula favoring states with more overdose deaths and treatment needs.
Maine ranked fourth among states for how much it allocated of its overall grant to treatment services: 81.9 percent. Meanwhile, the state ranked eighth for opioid overdoses, with 301 deaths in 2016.
Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services in Maine, said it was “misguided” for Maine to have refused to expand Medicaid and in doing so, decline federal matching dollars for expanded drug treatment services.
“These dollars could have been used for recovery efforts and ancillary services in recovery that folks are looking at across the country,” she said.
For example, Maine could have spent money to provide housing and transportation help for individuals in recovery, said Shaughnessy, whose group represents community behavioral health organizations across the state.
Maine plans to spend $1.2 million on opioid treatment services provided by seven Maine providers, according to the AP’s figures. The state also plans to direct about $238,000 on prevention efforts led by the University of New England and Rinck Advertising and $26,000 on recovery services provided by Healthy Acadia, which has offices in Ellsworth and Machias.
Emily Spencer, spokeswoman for Maine’s Department of Health and Human Services, said Maine directed Cures Act funding toward medication-assisted treatment in areas of the state with the greatest need. She noted that treatment efforts tend to cost more than recovery services, which she says Republican Gov. Paul LePage’s administration is expanding through peer-led centers, recovery coaches and “navigator services.”
“The state also utilized these funds to implement programs for individuals in need of a higher level of care, offering daily in-person doses of buprenorphine targeting agency waitlists and the homeless,” she stated. “Additionally, Maine used the available funds for recovery coaching services, as well as prevention-focused activities such as social media campaigns and community-based strategies.”
Thirty-three states have expanded Medicaid, receiving enhanced federal funding to cover poor adults. Historically, Medicaid has covered a large share of all addiction treatment in the U.S., more than all private insurance combined. Medicaid covers 4 out of 10 adults under age 65 with opioid addiction.
Last fall, nearly six out of ten Mainers voted to expand Medicaid, but the referendum lacked a funding mechanism for the state’s share. A legal and political battle over implementation has ensured.
The governor vetoed a funding bill using budgetary surplus and tobacco settlement dollars, and suggests the next governor instead raise taxes on hospitals. Meanwhile, his administration has issued at least 3,500 denial letters to Mainers seeking Medicaid coverage under expansion, which was estimated to help 70,000 to 80,000 Mainers.
Expansion states spent $1,581 per patient for treatment, the AP found. States that did not expand Medicaid spent $2,645 per patient on opioid addiction treatment on average, while Maine spent $721 on average per each of 604 patients.

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