Texans searching for lend a hand for substance use can name the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They too can get admission to products and services of their area in the course of the Texas Health and Human Services website.
After many years of treating low-income Texans combating substance habit, Phoenix House Texas is ultimate down all six of its outpatient clinics and its final residential treatment center for teens this week as a result of they are able to not depend at the state to lend a hand fund them, the nonprofit workforce’s director stated Tuesday.
The 28-year-old group is based closely on federal block grants administered in the course of the state to serve its most commonly low-income adolescent affected person inhabitants. And the nonprofit is the most recent casualty in an escalating investment crisis for Texas residential treatment facilities that comes because the state struggles with startling will increase in overdose deaths, specifically amongst younger folks.
“We feel like this couldn’t be worse timing,” stated Drew Dutton, CEO of Phoenix House Texas, which most effective treats youth. “This is when we feel like Texas needs us the absolute most, and we’re having to close our doors and turn away patients.”
By Friday, the gang’s residential treatment center Phoenix House Dallas could have closed its doorways to its 30 present citizens. It was once the final residential treatment choice for unfunded teens in North Texas, and is derived at the heels of the gang’s Austin residential center closure final month, which was once close down so that you can stay the community afloat.
That Phoenix House center was once additionally the one residential treatment for drug-addicted unfunded adolescence in Central Texas, Dutton stated.
The group may even close down its outpatient drug treatment products and services for youth at its different six places in Austin, Dallas, Houston, Round Rock and San Antonio, in addition to its digital products and services – which serve loads of sufferers a yr — and shift the point of interest fully to preventive products and services and public consciousness, Dutton stated.
The majority of Phoenix House sufferers are uninsured and will’t have the funds for maximum personal pay charges, which is why the facilities depend such a lot on federal greenbacks. The block grant quantities have a tendency to range through the years, and the state has from time to time raised charges in different sectors corresponding to outpatient products and services relying at the cash to be had, HHSC officers informed the Tribune.
The bills to residential facilities have most effective risen by means of 5% within the final decade, Dutton stated.
In an emailed observation, HHSC spokesperson Mike Parker stated in an e mail the company makes a decision on charges for block grant certified products and services in line with to be had grant investment.
Parker stated company officers weren’t to be had for a telephone interview in this tale with the Tribune.
Parker stated his company gives sources for adolescence ages 13-17 who want treatment in a area that has no choices, coordinating placement and extending get admission to via telehealth choices.
The state additionally collaborates with faculty districts to lend a hand scholars triumph over time and transportation stumbling blocks to treatment, Parker stated, and runs prevention and consciousness techniques throughout Texas.
But there nonetheless needs to be a spot to ship them, suppliers say. The Phoenix House announcement has despatched different Texas habit treatment suppliers — maximum of whom center of attention on girls and adults — scrambling to create extra or new capability for a brand new inflow of more youthful sufferers who can’t have the funds for treatment and not have Phoenix House Dallas to depend on.
Those different suppliers are dealing with the similar monetary hardships, after years of coping with stagnant state repayment charges and a slow-walking state pay construction they are saying drains their sources whilst prices upward thrust.
Youth180, a nonprofit based totally in Dallas that gives prevention, intervention, and outpatient treatment products and services to youth and their households, are having a look into including residential treatment beds following the closure of Phoenix House, officers there stated.
“This is devastating to those adolescents who are on government-subsidized insurance programs or are uninsured in the Dallas area,” stated Keri Stitt, president and CEO of Youth 180. “Their ability to access equitable care is significantly diminished simply due to their ability to pay.”
Texas leads the country within the quantity and charge of uninsured youngsters. When the ones children meet a well being care machine this is exceptionally underfunded, it may be devastating, Stitt stated.
Last Friday, Stitt stated, one in every of her medical institution’s 15-year-old sufferers who was once receiving extensive outpatient products and services overdosed in school. An area health center stored her over the weekend, however with out Phoenix House Dallas to soak up uninsured teens like her, she was once despatched again house on Sunday, Stitt stated.
The nearest residential treatment center for ladies is 2 hours away, an unimaginable shuttle for the low-income circle of relatives, Stitt stated.
“The family can’t drive to Tyler or Houston so there was nothing for them to do,” she said.
Stitt said since Phoenix House started winding down its services and word has spread about their closure of programming, their organization has seen their referrals double in a week.
Katharine Neill Harris, a drug policy fellow at Rice University’s Baker Institute, said facilities that focus on youth, as Phoenix House does, are often full.
“The closure of Phoenix House exacerbates the problem of treatment unavailability. It couldn’t come at a worse time, as drug-related deaths in Texas are increasing and more youth are exposed to powerful synthetic opioids like fentanyl,” Harris stated. “The closure highlights how unprepared Texas still is in the fight against the overdose crisis.”
Funding issues
Treatment centers, particularly those that provide residential services, have for years been pressuring Texas Health and Human Services to give them access to more federal block grant dollars intended to pay for substance abuse treatment for uninsured Texans.
“We are actually looking at a capacity crisis looming ahead,” Cynthia Humphrey, executive director of the Texas Association of Substance Abuse Programs, testified in a Sept. 15 HHSC hearing on the rates earlier this month. “It’s the residential providers that are bleeding the most, and are really at the precipice of whether they can continue providing services.”
It has gotten more difficult to staff them because it’s hard to pay them competitive rates, providers say. In fact, one provider in Victoria told HHSC officials at that hearing that staff had taken a pay cut in recent years to keep the lights on in their facility.
It’s also hard to attract staff to begin with, as the growth of telemedicine offers more opportunities for counselors and other employees to work from home — a perk that can’t usually be offered in a residential setting, said Dutton, Phoenix House’s chief executive.
On top of that, with the rise in use of fentanyl or drugs laced with fentanyl, a lot of the younger patients now require more intensive and costly treatments, Dutton said.
HHSC sets the rates each year on a per-patient-per-day basis, meting out to providers five-year block grants from the Substance Abuse and Mental Health Services Administration, an agency within the U.S. Department of Health and Human Services.
Dutton’s costs have gone up more than 30% in the past decade.Meanwhile, the state allotments have not met the rate of inflation, Dutton said. In 2014, the state reimbursement to residential treatment centers was $161 per patient, per day. Today, that rate has risen to $168.49 per patient, per day, he said.
“One point many providers have made is that you can hardly find a hotel for that price,” Dutton said. “But we are to provide 24 hours a day of licensed professional care, nursing, psychiatry, counseling, school services, three meals, two snacks, for that rate.”
At Phoenix House centers, which have seen such an influx of uninsured patients that they are now the majority of the group’s population, the state reimbursements now cover less than half of the cost of treating unfunded patients — meaning they operate at a loss every time they take in a new teenager who qualifies for the block grant reimbursement.
Dutton and other agency officials have for several years asked Texas HHSC to support an increase of for at least a 20% increase in the reimbursement rates.
Absent that, substance abuse treatment providers want that the entire amount allocated to them through the block grants be released to them at once, instead of in annual increments, so that they could access that money when they need it most.
“Why are you not providing those of us that use these dollars [the opportunity] to spend them down completely? Why? Nobody has been able to answer that question for me for three years, and trust me I’ve been asking,” Heather Ormand, CEO of Nexus Recovery Center in Dallas, asked HHSC officials during the hearing. “Those dollars are there for a reason, and we need them to keep providing the quality services that we do.”
In 2022, Phoenix House had been able to use less than 60% of their annual funding for the previous three years, leaving more than $3 million of unused funds for adolescent treatment on the table, Dutton said.
HHSC officials in an email said they are still reviewing public feedback and testimony from treatment centers and others delivered during a hearing two weeks ago on their latest rates for block grant reimbursements. This time, the agency staff proposed a potential 16% rate increase for residential centers.
The new rates won’t be announced until at least next week, but the latest proposals show no meaningful signs that this time would be any different for residential providers, Dutton and others told them in the hearing.
Last year, HHSC staff recommended that residential centers get an even bigger raise, but the request was declined and there was no change, he said.
“I really started to lose faith that we were going to get this right,” Dutton said.
During the hearing two weeks ago, several providers implored HHSC officials to consider how the state would be affected if treatment centers were to shut down.
“The ramifications are the ultimate demise of long-standing statewide service providers which will leave a devastating gap in services, with thousands of Texans unable to access critical [substance abuse] treatment,” said Gary Jenkins, president of the board of directors of the Alcohol and Drug Awareness Center for the Concho Valley, which offers residential treatment for adults in San Angelo. “We’re making an urgent appeal to you because we need your help.”
Ormand, of Nexus Recovery Center, said their organization has actively been trying to increase residential reimbursement rates for the past three years.
“The current and proposed reimbursement rates cover between 65-80% of our costs, depending on the program or level of care, and Nexus has intentionally diversified our revenue sources since 2020 to make up the difference between costs and rates,” she said.
That diversification mostly includes private fundraising, but also other public funds from Dallas County through the American Rescue Plan Act, which will go away in 2025.
“Nexus privately fundraised to cover 30% of our operating budget during FY23, which ended August 31, 2023, and we’ll continue to do so,” she said. “However, when funds go away from things like ARPA, the gap will be even greater if the proposed rates stay as published.”
Dutton said Phoenix House was approaching the same numbers with their fundraising. But because their costs had gone so high and the majority of their patients were uninsured, it was hard to cover the rising costs with donations they were able to secure.
Harris, of Rice University, called the closure of youth services at Phoenix House incredibly unfortunate, but not surprising.
“The unsustainably low reimbursement rates that HHSC pays to providers who treat uninsured patients is a longstanding issue in Texas,” she said.
During the Texas Legislature’s regular session earlier this year, parents whose children died from drug overdoses advocated for increased state spending on drug treatment and greater investment in youth substance abuse services.
They were denied, she said.
“The legislature could have used some of the $32 billion budget surplus to address this problem by providing [state] funding for provider rate increases. It chose not to invest in this area,” she said.
Ormand said her organization and others are assessing the needs in the community left by the absence of Phoenix House and doing their best to fill the void.
“We will step in to ensure no adolescents needing residential or outpatient services fall through the cracks,” said Ormand, whose center only serves women, including pregnant and parenting women.
Stitt said that unless the state steps in with better funding, the situation with Texas youth will just get worse.
“Childhood is what we spend the remainder of our lives getting over,” Stitt said. “We have a chance as a state to step up for the well-being of our kids as a result of they’re our long term. If we do not, and we expect adolescence drug use and overdoses are dangerous now, that is simply the end of the iceberg.”
Disclosure: Rice University has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete listing of them right here.
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