Connecticut is struggling to find providers of intensive substance use treatment for teenagers, despite winning approval to use federal dollars to pay for the service.
For the last two years, the state has not had a Medicaid-enrolled provider to care for adolescents with substance use disorder who need 24-hour residential care.
The state has been working to expand access to that treatment for several years. Historically, Medicaid did not cover certain residential or inpatient substance use treatment services, creating a gap in the state’s mental health care system.
Through a federal waiver program the state joined in 2022, Connecticut has received federal reimbursement for paying medical providers who offer those services to members of HUSKY Health, the state's Medicaid program. The goal is to reduce overdose deaths, decrease use of emergency departments and create a flexible treatment system better tailored to individual recovery plans.
Coverage spans from ambulatory care and withdrawal management to inpatient services.
But the state has been unsuccessful finding providers of residential care for teens. Rushford at Stonegate, an intensive residential treatment facility in Durham, had a program for teen boys with HUSKY Health until January 2024. No similar program for girls has been available in recent years.
Timely access to the right type of substance use treatment is especially critical for adolescents, whose brains and world views are still developing, said Connecticut's child advocate, Christina Ghio.
"You're talking about a crisis situation where families are experiencing extraordinary stress, trying to ensure that their child's needs are being met … " she said. "It's extremely challenging.”
Most adults with substance use disorder started substance use in teenage years. Adolescents with substance use disorder struggle compared to peers in multiple ways, including in education, employment, health and social relationships.
The Connecticut Department of Social Services (DSS) oversees HUSKY Health and runs the waiver program in coordination with several state agencies
"It is no secret that we do have struggles with that particular level of care for adolescents," DSS Deputy Medicaid Director Fatmata Williams said.
DSS and the Department of Children and Families (DCF) have been working to find other providers since before Rushford left the program. But financial issues, low utilization and the complexity of care have made it unsustainable for providers, Williams said.
"Adolescence is a period of growth," she said. "It's a period of instability. They need a lot of care compared to adults."
Keri Lloyd, a behavioral health program manager at DCF, said the department has met with potential providers, but they’ve been told that Medicaid reimbursement rates were too low — even after higher rates took effect July 1, 2025.
"There are financial concerns just based off of the unique needs of the adolescent population — balancing things like maintaining their educational needs while they're in treatment," Lloyd said. "Family engagement is incredibly important for young people while they are in treatment services."
The department has also reached out across state lines to find a provider, she said.
"We know that that's a service gap that has existed for quite some time," she said. "It is our hope not only to remedy the service gap for adolescent females, but also the now existing service gap for adolescent males as well."
Currently, DCF partners with commercial residential treatment providers in and outside of Connecticut to serve youth in need of treatment.
But that comes at a high cost for the state, Ghio said.
"It's not adequate," she said. "We really do need to ensure that we have a continuum of services available for children who have substance use disorder that includes that residential level of treatment when that is necessary."
The Office of the Child Advocate doesn't usually work on issues related to substance use disorder treatment, Ghio said. If the office does get involved, the child is most likely already in DCF's care and an individual agreement is made with a commercial provider. But that process is time consuming, Ghio said.
"We've not seen the kind of outcomes that we would like to see for children," Ghio said. "Again, talking about a very small number, but we have seen circumstances where even with that kind of individualized contract, the child still did not receive adequate and appropriate services."
Another challenge for the state is gauging the current need. State records show in the recent past, DCF documented a handful of kids each quarter who required residential substance use disorder treatment but were given alternatives.
The total population may be larger. Last year, about 2,200 youth who filed Medicaid claims had a substance use disorder diagnosis, Lloyd said. That number doesn't include claims made when a youth sought outpatient care.
"What we don't want to build out is something bigger than what we actually need in our state," said Kris Robles, DCF's behavioral health clinical manager.
