Cold turkey at clinics

The survival of substance abuse clinics providing treatments to addicts in Detroit and Wayne County is in jeopardy because they haven't received Medicaid reimbursements since October 1 and don't know when payments will be made.

At least nine clinics serving an estimated 4,500 addicts are being affected, according to Lucila Ryder, vice president of the Michigan Association of Methadone Providers.

The problem is the result of a change in the way Medicaid funds are processed. The state provided Medicaid reimbursements prior to October 1, when the responsibility shifted to local coordinating agencies. In Detroit, the city's Health Department was handed the responsibility.

"Beginning in October we had a tremendous number of new contracts, so there have been some delays," said Judith West, interim director of Detroit's Health Department. "We are in the process of approving contracts, and all providers will be paid."

The big question is when. West wouldn't say. According to providers, they are being told that it might not be until January or February that the checks arrive. By then, it may be too late for some.

"We have not been reimbursed at all since the beginning of October," reports Mary L. Doss, director of Detroit's Comprehensive Services. "We missed our last payroll and it looks like we won't be able to pay people again this Friday."

Compounding the hardship is that many clinic workers subsist on salaries of less than $25,000 per year, making them particularly vulnerable when paychecks are missed.

Other clinics -- especially the smaller ones that exist primarily on Medicaid funding -- are finding themselves in the same dire straits. Some are attempting to obtain loans to keep their programs afloat, others have had trouble making payments needed to keep their phones working and doors open.

Should clinics begin closing their doors, it will mean addicts will have to fend for themselves in looking for ways to feed their habits.

"You haven't seen problems until you've seen all these people on the street with no place to go," said one clinic director, who feared that addicts would turn to crime to pay for drugs should the methadone treatments be cut off.

"It's not just crime," said Ryder. "There's also the problem of disease being spread.

"I think we'll be lucky if we receive payment before February," said Ryder. "If it takes that long, I don't know how long some of these clinics can survive. They're surviving on a prayer right now."

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