SOME TEXAS DRUG ABUSE TREATMENT PROGRAMS TO CHANGE UNDER MANAGED CARE

Jul. 1--Each morning, about 20 people are waiting outside the Greater Dallas
Council on Alcohol and Drug Abuse when the doors open.

Some are trying to shake off hangovers. Others are strung out on drugs. They
come to the council for an assessment of their condition and referral to
treatment.

Starting Thursday, however, the low-income residents seeking help for drug
and alcohol abuse must navigate a new managed-care system intended to save
the state money.

About 32,000 substance-abuse and mental-health clients in Dallas, Collin,
Ellis, Hunt, Kaufman, Navarro and Rockwall counties are expected to be
served by the new system, called NorthSTAR.

Some advocates of drug and alcohol treatment say that more attention has
been focused on NorthSTAR's mental health component. They worry that many
people in dire need of drug or alcohol treatment haven't heard that a
fundamental shift is beginning in the way they receive services.

"These clients are very vulnerable," according to a report this month by the
Greater Dallas Council on Alcohol and Drug Abuse. "Any obstacle to receiving
help is often used as a reason to give up and return to the
self-destructive, family-destroying behaviors that cost much pain for
individuals, families and our community."

The council found last week that almost 80 percent of clients it surveyed
had not heard of NorthSTAR. Only one of the 44 people surveyed had enrolled
with either of the two managed care companies.

Once the new system begins, non-Medicaid clients receiving public
substance-abuse treatment will be assigned to one of the companies, Magellan
Behavior Health of Texas or Value Options. The plans offer similar benefits,
and consumers can change companies after enrollment.

Officials with Magellan and Value Options predict that alcohol and drug
abuse treatment will improve because consumers will have a wider choice of
providers. However, some advocates fear that more people may relapse because
managed care companies have a financial incentive to shorten treatment and
limit residential care.

"The ballgame is changing," said Lois Olson, executive director of Dallas
Helps, an advocacy group for substance abuse. "It's going to be a huge
change from the providers' perspective. I think they're going to have to get
used to making strong clinical justifications for people to be there.

"For the first time, somebody else is going to be setting those limits. They
1/8managed care companies 3/8 are going to push for the least-restrictive
level of care."

Douglas Denton, president of the Dallas Area Substance Abuse Network, said
he, too, was concerned about people getting adequate treatment under
NorthSTAR.

"We've been working with the managed care companies to develop an
understanding about the nature of our typical client," Mr. Denton said.
"They are overwhelmingly homeless, unemployed and undereducated. We wanted
to make sure that the proper level of care is given to these clients.

"Many have a chronic history of substance abuse. I have concerns about the
potential for relapse."

Magellan may require shorter treatment stays for some people, said Bob
Waters, its executive director. Studies have shown that outpatient care with
good follow-up can be as effective as residential care, he said.

"Residential care is certainly not the only answer," Mr. Waters said. "We
want a balanced approach."

Value Options tries "to provide services in the least-restrictive
environment," said Carole Matyas, executive director of its NorthSTAR
program.

"There may be lengths of stay that are shorter, but if a member meets the
criteria to be in residential, they're going to be in residential," she
said. "Sometimes people stayed in residential because there weren't
alternative treatments. Under the new system, they have other services they
can go to."