AUGUSTA — A law that took effect Jan. 1, designed to save the state money by cutting MaineCare patients’ methadone treatments after two years, has so far resulted in 20 people losing coverage, according to early figures from the Maine Department of Health and Human Services.

So far, another 1,197 have received waivers to stay on the treatment for opiate addiction.

Each of those yearlong waivers, also known as prior authorizations, was recommended by a methadone clinic medical director and approved by the state. Of the 20 people who have been cut, the extension was denied to 15 because those patients no longer qualified for MaineCare, DHHS spokesman David Sorensen said.

At the end of 2014, more than half of the people taking daily doses of methadone — 2,251 of the 4,048 — were covered by MaineCare. Those who had been on it for two years or longer had to ask for waivers come Jan. 1.

On Friday, Stefanie Nadeau, director of the Office of MaineCare Services, wasn’t able to say how many people had hit the two-year limit and hadn’t sought a waiver.

She said the state needed 90 days to tally that number, as well as any savings.


More than $15.5 million in state and federal funding was spent on methadone treatment and transportation for MaineCare patients in 2013. In 2012, when the new law was added to the supplemental budget, discussion focused on reducing those costs.

Critics at the time argued that two years felt arbitrary.

“Generally speaking, it’s a population where it’s appropriate to remain in treatment for as long as is necessary based on their life situation, their medical situation, their family situation,” said James Cohen, an lawyer working with the Coalition to Ensure Fair Access to Opiate Addiction Treatment, a group of Maine methadone clinic operators. “It’s hard work to stay in treatment. Usually, if they taper off the drug before they’re ready, the relapse rate is in excess of 80 percent.”

Maine has 10 methadone clinics, including Merrimack River Medical Services in Lewiston, which has 248 patients; 192 are covered by MaineCare.

The state pays clinics $60 a week for each MaineCare patient, Cohen said, and patients contribute a $2 co-payment.

While clinics didn’t initially favor the two-year limit, they agreed to work with the state on the prior authorization process, he said.


What’s in place now, Cohen said, is “fair and reasonable.” Clinical medical directors sit with patients and weigh a host of factors, including recovery environments and “readiness to change.” The findings are then reviewed by the state.

“You really want to make sure that the patient is ready,” Cohen said. “Otherwise, that patient ends up in the emergency room, (loses) the ability to care for dependents, loses their job, steals, et cetera, so it’s really important to make sure that the patient is ready to transition off.”

Between Nov. 17 and Dec. 31, clinics submitted requests for 1,286 prior authorizations, according to Sorensen. Of those, 1,197 were approved, 69 were accidental duplicates, five were canceled by the clinic in-process and 15 were denied because those people had lost MaineCare coverage.

People denied extensions are allowed several months to cycle off in a “medically appropriate withdrawal,” Cohen said. 

“I’m sure there are some who are stopping treatment,” Nadeau said. “The hope is those providers and (patients) were talking about this policy prior to Jan. 1, 2015, and the conversations have been ongoing so they can get the person to the place where they may not need the medication or the treatment any further.” 

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