Kentucky Leads Again in Addiction Treatment and Recovery | Opinion

A Shift in Addiction Recovery: From Hope to Exploitation

Kentucky was once a leader in addiction recovery. The state made significant strides by expanding Medicaid to cover treatment, investing in community-based programs, and showing a commitment to helping individuals on the path to recovery. These efforts demonstrated a strong belief in the value of care over cost.

However, the landscape has changed dramatically. Today, profit-driven providers and systemic loopholes are undermining the quality of care available to those in need. What began as a system designed to support people has transformed into a business model that prioritizes cheap labor and low-value services. This shift has had serious consequences, with the largest behavioral health provider in the state currently under federal investigation, highlighting the depth of the crisis.

The Problem of Intern Labor

One of the most troubling aspects of this situation is the reliance on interns as a source of cheap labor. Some providers have been criticized for using what amounts to indentured servitude, offering minimal compensation and reduced rent in exchange for essential duties such as admissions, drug testing, and transportation. These responsibilities should be handled by trained professionals, not unqualified individuals.

In some cases, more than 100 interns at a time were paid as little as $75 per week. These individuals often relied on food stamps and Medicaid for basic needs while the companies billed Medicaid for their work. This practice not only exploits vulnerable individuals but also undermines the integrity of the entire system.

Weakening Peer Support

Another critical issue is the weakening of peer support systems. Peer support is meant to provide guidance from individuals who have successfully navigated recovery, offering empathy and understanding to those just starting out. When done effectively, it can be one of the most powerful tools in the recovery process.

However, in Kentucky, this model has been diluted. In some instances, Medicaid was even billed for individuals attending free Alcoholics Anonymous (AA) meetings, treating them as if they were receiving formal treatment. Recent changes in state law have worsened this issue by creating "temporary" peer support specialists who can bill Medicaid with minimal qualifications. Additionally, non-clinicians are being reimbursed at the same rate as licensed clinicians, which is akin to allowing someone without a medical license to charge the same as a doctor.

This approach has led to a system that values quantity over quality. Data shows that patients receiving these non-clinical services often experience worse outcomes, including higher emergency room visits, more hospitalizations, and increased relapses. Rather than fostering independence, these models create dependence, trapping patients in a cycle of repeated care.

The Abuse of Psychoeducation

Psychoeducation, which involves basic information sessions about addiction and recovery, is another area where the system has gone awry. While this type of education should be part of regular counseling, it has become a separate service that is reimbursed by Medicaid. Kentucky is unique in this regard, as most other states do not pay for psychoeducation in this way.

The recent expansion of this service has further fueled its profitability. It is now no longer limited to one-on-one sessions, making it even more lucrative for providers. This trend reflects a broader pattern: low-value services are being rewarded, while real clinical care is shrinking.

A System in Crisis

The issues facing Kentucky’s addiction recovery system are not just policy problems—they have become law enforcement concerns. Over the past few years, there have been numerous federal investigations, including FBI raids, indictments, and prosecutions of providers caught exploiting Medicaid and addiction services.

Despite these efforts, state investigations remain understaffed and overwhelmed, leading to long backlogs that can take years to resolve. This delay allows unscrupulous providers to continue operating, draining taxpayer dollars in the process.

A Path Forward

Kentucky does not have to accept this status quo. There are clear steps that can be taken to restore the integrity of the system. First, all staff should receive fraud-prevention training at the time of hiring and every six months. Second, fair compensation should be provided for actual therapy delivered by licensed professionals. Finally, the reliance on interns and under-trained peers as the backbone of a cheap business model must end.

Kentucky once set the pace for recovery innovation. With the right policies and a commitment to valuing people over profit, the state can reclaim its leadership role in addiction recovery. It is time to stop rewarding practices that exploit both patients and taxpayers and instead invest in meaningful, sustainable care.