The End of Long-Term Drug Rehab 

State and federal officials are expected to eliminate funding for long-term residential drug treatment programs as part of an overhaul of MediCal.


In 1988, Angela Porter hit bottom. She was just 22 years old at the time, but her crack cocaine habit had consumed her life. She lost her friends, her family, her home, and her dignity. Homeless, alone, and broke, she resorted to knocking on people's doors in Berkeley and begging for money.

As she slept in some bushes one night, a man tried to rape her. She fought him off and barely got away. "I was dirty, broken, and too ashamed to reach out to my family," Porter recalled in a recent interview.

One morning, as she walked the streets of Berkeley, a desperate, cocaine-addicted wraith of her former self, everything seemed to be going in slow motion. She hadn't slept in four days, and she was certain she was hearing things.

She picked a house at random and knocked on the door. Porter asked the woman who answered if she could use the phone. Inside, Porter pretended to make a call, as the woman stood nearby making breakfast. Porter then spotted a purse on the floor. She hung up the phone, grabbed the purse, and made a beeline for the front door. Once outside, she was too sickly to run, so she hobbled down the street. She made it about two blocks from the house before a neighbor who looked like he weighed about four hundred pounds chased after her on a moped. The large man jumped off, tackled her, and then lay on top of her until police arrived.

After spending three days in jail, Porter never wanted to go back. A couple of inmates beat her and stole her blankets. Jail smashed through the drug-fueled madness that had clouded her reasoning. '"What has happened to me? What have I become?"' she recalled asking herself. She remembered all the things she had done — things she had told herself she would never do — for drugs. '"This is not who I am. I need help."'

The court offered her the chance to go to rehab — or spend two years in Santa Rita Jail. She chose rehab.

Porter went to New Bridge Foundation, a long-term residential facility in Berkeley that caters to the most stubborn and hardcore drug and alcohol abusers who can't afford private treatment. At New Bridge, residents live in a highly structured environment and adhere to strict rules. The program is designed to get at the core issues affecting drug abusers and change the way they think and behave. Through structure, discipline, and group therapy, Porter learned how to stay off drugs, be responsible, and function in society.

But getting sober wasn't easy. New Bridge is a long and challenging program. Back then, the inpatient program lasted twelve to eighteen months, with another six months in supportive housing, which was still structured, although clients could leave for work and have social time.

Over the years, the number of long-term residential treatment programs like New Bridge has declined in the East Bay and throughout the state, fueled in part by a lack of funds and by newer treatment methods, which favor shorter stays and more outpatient programs in which clients take classes by day and return home at night. As a result, New Bridge and many other publicly funded long-term residential centers in California have been forced to shorten their programs to no more than six months.

And if the state gets its way, the lengths of stay might get even shorter — so much so that it wouldn't be accurate to call such treatment long-term anymore.

Right now officials for MediCal — California's version of the federal Medicaid health insurance for the poor — are ironing out the details with the federal government on what could be the most significant overhaul of the substance abuse field in California history. If approved, the planned changes would radically transform the substance abuse landscape, altering how providers do business and how poor people like the 22-year-old Porter get treatment. The state is promising to provide more people with more treatment options, including detox, methadone maintenance, and outpatient care. Most importantly, for the first time, it will offer short-term residential care to those with MediCal.

But the overhaul may also result in the death of the long-term residential care system as we know it by limiting stays to no more than ninety days. Porter said some of the reforms proposed by MediCal officials make sense. A lot of people who didn't have access previously to residential care would now have that benefit, she noted. However, while the planned overhaul might look good on paper, "what happens to folks who need more services?" she asked.

For Porter, treatment is more than just getting people clean and sober. It is about learning how to live. "If I didn't go to New Bridge," she said, "I'd be dead."

In 1965, Congress created Medicaid, a sweeping federal program that gives children, low-income parents, the disabled, and the elderly access to medical services that they otherwise can't afford. California's version of the new medical assistance program is called MediCal, and both the federal and state governments fund it.

But within the law establishing Medicaid, Congress banned funding for residential care facilities. The ban was intended to keep states from warehousing the mentally ill, but it also applied to substance abuse treatment centers.

The exclusion, however, has exceptions. MediCal will pay for substance and mental healthcare residential treatment programs for women in the perinatal period — just before, during, and after birth of a baby. The ban also only applies to residential facilities with more than sixteen beds. However, the high cost of operating a residential rehab makes it nearly impossible to financially survive on sixteen or fewer beds. In California, 90 percent of publicly funded rehabs have more than sixteen beds, meaning they mostly survive on non-MediCal funding.

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