The Ohio Department of Medicaid says it is working on a proposal to the federal government to allow the health-insurance program to cover some of the care at Brigid's Path, the state's only standalone recovery center for drug-exposed infants.
The nonprofit center opened in December in the Dayton area and has had to limit services to eight infants at a time, despite high demand and 24 beds. In a Dispatch story on Brigid's Path last week, executive director Jill Kingston said the Medicaid exclusion keeps her from being able to afford more employees.
"One hundred percent of our babies are Medicaid-eligible," Kingston said. "We just can't bill."
Many drug-treatment services for adults on Medicaid have long been covered. But the concept of an inpatient, non-hospital setting focused on infants diagnosed with neonatal abstinence syndrome — the medical term for withdrawal symptoms suffered by newborns — is relatively new and doesn't fit Medicaid guidelines.
Securing coverage requires either a change in federal law or for states such as Ohio to receive approval from the Centers for Medicare and Medicaid Services to amend their state plans.
"We are in talks with CMS to figure out how we can make a proposal work," Ohio Medicaid spokesman Tom Betti said last week. "We value the work that Brigid's Path is doing."
Legislation introduced two years ago by Ohio Democratic Sen. Sherrod Brown and West Virginia Republican Sen. Shelley Moore Capito would provide a fix at the federal level by allowing pediatric recovery centers throughout the country — advocates expect more to be developed — to receive reimbursement from Medicaid.
The CRIB (Caring Recovery for Infants and Babies) Act finally passed the Senate Monday night as part of a larger package of opioid-focused initiatives, but it still has to be reconciled with related House bills, Brown's office said.
The nation's first and only other recovery center for infants is Lily's Place, which opened four years ago in Huntington, West Virginia. Both Ohio and West Virginia have been hard-hit by the opioid epidemic and have high rates of newborns who come into the world dependent on the drugs their mothers used during pregnancy.
West Virginia went the state amendment route and received approval in February to cover services in neonatal abstinence syndrome treatment centers such as Lily's Place. "This critical designation will allow us to treat the most vulnerable, innocent victims affected by this horrible crisis," Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, said at the time.
Once they're medically stable, infants going through withdrawal or recovering from drug exposure often do better in quiet, home-like settings, away from the beeps and alarms and bustle of neonatal intensive-care units, experts say. Rooms at Lily's Place and Brigid's Path are quiet and private, with plenty of room for parents to visit and to participate in the infants' care.
"It's also cheaper than hospitals," Kingston said.
Brigid's Path tried to engage Ohio Medicaid to seek federal approval to cover care at the center more than three years ago, before it was close to opening, she said. For now, it relies on donations, grants and a $1 million appropriation in the current two-year state budget.
"I want a change that will help not just us but other organizations, too," Kingston said. "If you listen to what Medicaid wants for the mom and the baby, we're doing all of that. And we're going to keep doing it."