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Anyone who has worked in the substance-use disorder treatment field for more than 90 days has seen this issue firsthand and wondered what’s really going on (“Fraud claims imperil treatment,” front page, Feb. 19). Providing housing during treatment isn’t just noble — it’s essential. Safe, stable living environments are a requirement for recovery. At the same time, we’ve all seen how housing stipends can create incentives for people to enter treatment when a housing-first approach might better serve them, or how treatment groups sometimes include individuals who are primarily seeking housing rather than long-term care.
Naturally, we’ve questioned how programs can provide $500, $600, even $750 per month in housing stipends for every client while still claiming that Medicaid dollars aren’t being used for housing — something federal law prohibits. (To Nuway’s credit, they at least operate a nonprofit that ostensibly funds these stipends.) We’ve all wondered about the legality and sustainability of this model, and many of us have imagined the chaos that would unfold if the state suddenly reversed course.
But here’s the reality: We’ve been asking these questions for years. The state has known about this practice, reviewed it and signed off on it — year after year, audit after audit — allowing it to become deeply embedded in Minnesota’s SUD treatment system. The result? Intensive outpatient programs have no choice but to offer these stipends to remain competitive. Every few years, the Department of Human Services audits these programs, reviews their policies, procedures and billing, and ultimately approves them. And when DHS flags an issue, providers like Nuway adjust their practices to stay compliant.
Now, we are on the precipice of a disastrous decision that could leave thousands of vulnerable Minnesotans homeless — in the middle of winter — simply because no one wants to take responsibility for finding a sustainable solution. DHS cannot claim ignorance. If they suddenly cut off Medicaid payments to the Twin Cities’ largest SUD treatment provider — only after a KARE 11 exposé forced them into action — people will die, front-line workers will lose their jobs and the system will not be improved.
DHS needs to step up and develop a reasonable, sustainable path forward — one that leads to meaningful, systemwide reform without creating a humanitarian crisis.
I, for one, will be watching closely — and bracing for the fallout.