If Utah’s Medicaid waiver isn’t approved by Nov. 1, Operation Rio Grande might enter the new year without three-quarters of the drug treatment beds that leaders have promised.
That’s part of the message Gov. Gary Herbert, House Speaker Greg Hughes and a cadre of Utah officials delivered Sept. 29 in a Washington, D.C., meeting with Health and Human Services Secretary Tom Price — repeating themselves, for emphasis.
But in the middle of their meeting, Price stepped out to take a phone call.
It was the White House, he told them when he returned.
“He was visibly distracted after that,” said state Sen. Todd Weiler, R-Woods Cross. “It was clear to me he just wanted to end the meeting.”
By the next morning, Price had resigned amid reports that his travel arrangements had cost taxpayers more than $1 million since May.
Weiler and other Utah officials said Price’s untimely exit hardly dooms Utah’s 2016 Medicaid waiver request, which targets about 6,000 childless adults who are chronically homeless or in need of mental health and drug-addiction services.
But it might be a setback for Operation Rio Grande, which is well underway and was expected to consume about $7 million of the expansion for drug treatment.
The urgency has been such that Utah has asked Centers for Medicare & Medicaid Services to strictly consider its 2016 waiver request — forgetting, for now, 2017 amendments that would add a lifetime cap, emergency room copayments for non-emergencies and other limits to health-care eligibility.
Service providers require a guarantee of Medicaid expansion to begin creating 180 new Operation Rio Grande treatment beds — a bigger long-term financial risk for them than the 61 beds they have already opened during the first two-and-a-half months of the operation.
Odyssey House would need extensive renovations to create 100 more beds. First Step House would rent a new facility for the other 80 beds expected, and Executive Director Shawn McMillen said Thursday that approval of the Medicaid waiver will likely be a condition of its lease agreement.
“The Trump administration is certainly significantly warmer to all of this — this kind of state action — than the previous administration, but this is a hiccup, a real hiccup, that Secretary Price resigned,” he said.
Salt Lake County Mayor Ben McAdams visited the Salt Lake County jail Thursday after two dozen beds became available at Odyssey House, to be filled with inmates via the county’s new Operation Rio Grande drug court.
“Their hopes for treatment were high,” he said. “They’ve hit rock bottom, and they’re ready to change.”
But McAdams said service providers need those assurances if they’re going to work toward the larger third and fourth waves of beds — if not from the feds, then perhaps from state legislators — as “even just delays will harm our ability to bring treatment online.”
“If we don’t have the funding for treatment, then really all we’re doing is warehousing people, and we know that’s not successful,” he said.
Officials stressed repeatedly that they couldn’t merely arrest their way out of heroin’s grip on Salt Lake City’s Rio Grande neighborhood. They needed treatment beds — as many as possible, as soon as possible — and had repeatedly stated their optimism that the waiver would soon be approved.
McMillen said he’s spoken to Hughes and knows the speaker to be a strong proponent of treatment. He’s not as sure, though, that the wider Legislature would be interested in spending additional state money — for what is sometimes whispered about as a “Salt Lake City problem” — if the waiver doesn’t come through. Hughes didn’t reply to a request for comment for this story.
Meanwhile, 300 jail beds have been made available through Operation Rio Grande at an expected cost of $15 million, with the tab for two years’ worth of stepped-up law enforcement predicted to be $19 million. More than 1,500 arrests and jail bookings had been made as of Friday morning.
Weiler said Price’s exit likely jeopardizes the state’s ambition to have the waiver approved by Nov. 1, given that “it’s going to be difficult for HHS to approve something like our waiver without a secretary in place.”
“It will be up to [Acting Secretary Don Wright] how far he wants to stick his neck out,” he said.
But Rep. Jim Dunnigan, R-Taylorsville, was also at last week’s meeting, and he thinks it can happen before a new secretary is confirmed. Even as Price was out of the office, he said, the Utah group was emphasizing the seriousness of its timeline to a receptive and attentive audience in Centers for Medicare & Medicaid Services boss Seema Verma and Medicaid Director Brian Neale.
Hughes has repeatedly told the story of Dunnigan chasing down Verma at the National Conference of State Legislatures in July — to which Dunnigan laughed that he “didn’t really chase her down, but I made sure I had a personal conversation with her before she left the building.”
“She said, ‘I won’t forget you.’ She said CMS has been the agency of ‘No.’ She wants to make them the agency of ‘Yes.’”
“I don’t think we need to wait on a new secretary. I don’t think it requires a secretary’s approval,” said Dunnigan, the waiver’s 2016 sponsor. “I think it’s very much in keeping with what President Trump has said he wants to do — to let the states have latitude and be the innovators.”
Herbert’s office said in a statement that it had no comment on Price’s resignation but that “we have confidence in the HHS/CMS processes for reviewing and approving Utah’s waiver requests.”