Members of the Columbia County Board’s Finance Committee said Thursday they need a little more time, and a lot more information, before deciding whether the county’s program for opioid addiction should be operated in-house instead of contracted out.
For at least another year, Health and Human Services Director Dawn Woodard said, having the county operate its Medication Assisted Treatment Program would not cost county taxpayers a cent.
But Finance Committee members said they’d like to compare, side by side, the pros and cons of operating the program in-house or hiring an agency to oversee it.
“It’s awkward and a little uncomfortable” to make a decision like this without more time and information, said Finance Committee Chairman Dan Drew of the town of Pacific.
Committee member Barry Pufahl of Pardeeville said the issue is not whether the Medication Assisted Treatment Program is valuable in addressing the epidemic of opioid addiction.
“It is very much needed,” Pufahl said. “But does it need to be done in-house?”
Columbia County had contracted with the health services firm Tellurian to administer the program, which is entering its third year. About 387 people have sought the program’s services, which often entail treatment with drugs such as Suboxone and Vivitrol, designed to end addiction to opium-based drugs, including not only heroin but also prescribed painkillers like Percocet and Oxycontin.
Woodard told the committee the state has awarded Columbia County a $350,000 grant, running from Aug. 1 through July 31, 2019.
That’s more than enough, she said, to hire three social workers on a limited-term employment basis and cover other costs of an in-house program, such as office facilities, computers and training.
Woodard said an in-house program would serve Columbia County better than a contracted program in the following ways:
- Treatment program social workers who are employed by Columbia County, as opposed to a contracting agency, could work more directly with other Health and Human Services programs that address the consequences of opioid addiction — programs like Drug Court and Child Protective Services.
- In-house staff can do a more consistent job of data entry, to document the progress of participants, than a contracted service like Tellurian is able to do.
- If the program is operated in-house, then any equipment acquired with the grant money, such as desks and computers, would stay with the county even if the grant is not renewed — whereas the same grant-funded acquisitions for a contracted agency would remain the property of that agency when the contract ends.
- In-house operation offers an opportunity to determine if the treatment program can be sustainable with money sources other than grants. For example, Woodard said, most of the program’s current clients are eligible for the state’s Medicaid program, and accounting employees at Health and Human Services could bill Medicaid.
Woodard said Columbia County officials had intended to continue contracting with Tellurian through August 2019, but the contract is being terminated because the agency has not been able to hire and retain enough qualified workers to operate the program efficiently.
Tom Engels, director of business development at Tellurian in Madison, could not be reached for comment.
Woodard acknowledged, however, that Columbia County is likely to face the same challenge of finding and keeping social workers, should it take over the program’s operation. She added it’s likely that social workers would prefer to apply for permanent social work jobs, and even those who apply for a position that’s only guaranteed for a year would likely want to seek permanent full-time posts as soon as they become available.
County Comptroller Lois Schepp said it also would be a challenge for the existing HHS accounting staff, which is already overworked, to take on additional responsibilities such as billing Medicaid.
Woodard said the grant might be able to pay for additional accounting time, but probably would not fund an additional full-time accounting position.
Two members of Columbia County’s Health and Human Services Board told the Finance Committee they believe the Medication Assisted Treatment Program is essential.
“In a relatively short period of time,” said Supervisor Nancy Long of Lodi, “this program has been successful at helping people. It is making a difference in people’s lives.”
Tom Drury, a citizen member of the HHS Board, said a decision not to fill the three limited-term social worker positions for an in-house program could put the program in jeopardy.
“This problem is not going away, unfortunately,” he said.
Drew said the value of the program is not the issue. Rather, he said, the question is whether it’s better, and financially viable, to operate the program at the county level instead of contracting it to any outside agency.
The process for setting Columbia County’s 2019 budget is scheduled to start soon, and one option might be to request the three limited-term social workers’ positions as part of the budget process — noting that no county tax dollars would be needed to pay their salary and benefits through the end of July.
After that, however, the question would be whether to terminate their employment if the grant is not renewed, or find other sources of money to pay for the posts, said County Board Chairman Vern Gove of Portage.
“I think this is needed; I really do,” Gove said. However, he added, it could pose a budgetary challenge if the grant money dries up.