In wake of DHS overpayments, tribe scrambles to continue opioid treatment

A Minnesota tribe struggling with the devastating effects of the opioid epidemic is scrambling to continue its treatment program that had its funding slashed after it was revealed last year that the state made millions of dollars in overpayments.

In a series of interviews with 5 INVESTIGATES, the chairman of the Leech Lake Band of Ojibwe, one of the two tribes that received the overpayments, said the tribe is also now prepared to sue the state if it is asked to repay nearly $15 million to the Department of Human Services.

"We don’t have that in our tribal coffers to make a repayment like that, and more so we feel it wasn’t our mistake," said tribal chairman Faron Jackson. "We were following the expertise of DHS."

Tribal leaders have been shuffling around money since last spring to keep its opioid treatment program operating, after DHS revealed it had been reimbursing at the wrong rate for treatment over the last five years. In all, DHS overpaid nearly $30 million to Leech Lake and White Earth Nation – two tribes that provided recovering addicts with take home doses of Suboxone, a drug that reduces cravings for opioids.

The taxpayer money funneled through the state was a pivotal piece to the tribe’s health and human services budget. Tribal officials said it had to cut funding to a total of eight other programs in order to continue the treatment program.

Jackson said the program is the best option to address the epidemic that has particularly ravaged reservations across the state and he fears what could happen if it goes away.

"That would be devastating right now if that were to happen. Our reservation isn’t ready for that right now," Jackson said.

Over a span of four months, 5 INVESTIGATES traveled to the Leech Lake reservation to meet with tribal leaders, addiction specialists, and people impacted by the opioid epidemic and the sudden loss of DHS funding.

Jackson, who has led the tribe for four years, has a personal connection to the opioid crisis. He lost two children to drug overdoses, and has adopted five others also affected by opioids.

"We have a deep rooted understanding of the whole complex issue of how these things happen," he said. "It just shows us really how everybody is impacted one way or the other. It doesn’t choose certain people."

The Leech Lake opioid treatment program was established in 2004, but the tribe did not start offering Suboxone to people battling addiction until 2014.

Barb Johnson, who manages the program, says they average about 70 clients at any one time.

"It’s a life changing event to complete the program, to get out into the community without medication," she said.

Since its inception, nearly 700 people have gone through the program, which has evolved to include Native American cultural and traditional healings beyond medicated assisted treatments.

"Some have the idea as soon as they get in here they would like to be off the program in a number of months. A few months. It doesn’t work that way," Johnson said. "They have to be psychologically prepared — not having fear of not having something to stave off the cravings."

Clients begin the program by making daily trips to the tribe’s treatment facility in Cass Lake. As they progress through the program, they can eventually earn take-home doses of the medication, reducing the number of trips for treatment.

The length of treatment varies from patient to patient, but they share the same goal — to wean off Suboxone.

Gary Headbird, Jr. has been in the program for more than 600 days of treatment. The 37-year-old has struggled with drug abuse for most of his adult life.

"I just liked that feeling that it gave me. I was looking for something to… shut my mind off things and failures," he said.

Headbird checks in once a week at the treatment facility where he receives another week’s worth of medication. He begins each morning by placing a tiny strip of Suboxone under his tongue from the comfort of his own home.

The tribe should have been reimbursed roughly 20-dollars for each dose provided to Gary and anyone else in the program.
However, for the last five years, they were reimbursed at a significantly higher – and wrong – rate. Last year, DHS paid out $455 for every take home dose of medication.

Correcting the DHS overpayments sent the tribes into financial chaos, led to strained relationships with the state, and left both parties with unanswered questions about who is ultimately responsible, according to a report released in October by Legislative Auditor Jim Nobles.

Nobles told lawmakers during a hearing last fall that he believes the problem was caused due to "dysfunction" at the state’s largest agency and said recouping the money could prove difficult.

"We were never consulted… it was just laid on us that we owed all of this money and that’s why we were kind of scratching our heads," said Jackson. "They dropped this bombshell on us and we were just astonished by what we were told."

Other tribal officials explained to 5 INVESTIGATES that while they’re prepared to take legal action, they are currently in talks with DHS, federal officials, and are hopeful lawmakers will resolve the issue during the 2020 legislative session.

Sarah Berg, DHS spokesperson, declined requests for an on-camera interview with Commissioner Jodi Harpstead, but wrote in an e-mail that Harpstead is "interested in looking at the current state of opioid treatment and hopes to involve the new medical director."

In response to specific written questions, Harpstead said in a statement that "we want to work with legislators, Leech Lake Band of Ojibwe and White Earth Nation to find a solution that ensures critical services are not impacted."

Life on Leech Lake

The Leech Lake reservation touches four counties in a stretch of land about three and a half hours north of the Twin Cities. The reservation itself is roughly twice the size of Hennepin County, wrapping around the lake it’s named after.

"My heart is right here, just in the community with the people," said Mike Robinson, Assistant Chief of the Tribal Police Department. "There’s no better place to live than right there."

But Robinson acknowledges that his home town has struggled with addiction for decades – beginning with heroin and meth in the early 2000’s and the more recent opioid epidemic that continues to shape the reservation today.

Native Americans are six times more likely to die from an opioid overdose than white men or women in Minnesota, according to the Minnesota Department of Health.

"I think it has hit us pretty hard. We have had our fair share of overdoses and violence and it’s all related to it," Robinson said. "It’s just like any other place. We aren’t immune to it."

Still, he finds hope in the younger generation that has grown up during the depths of the epidemic.

While patrolling the reservation in mid-December, he stopped at the big rivalry basketball game between Cass Lake and Red Lake high schools. He called it an example of a positive outlet that encourages students to stay in school and away from drugs.

But as fans were still filtering into the game, paramedics responded to the school parking lot where they found a mother of seven slumped over behind the steering wheel. Police found prescription drugs in the van and her baby in the backseat. The woman was later charged with possession and driving under the influence.

The episode is an example of the current reality on the reservation, but it hasn’t diminished hopes for the future of the program.

Band of Hope

Despite the looming threat of repaying millions, or a potential lengthy legal battle, tribal officials and clients expressed hope for the future of the opioid treatment program.

Barb Johnson declined to comment on the overpayment issue but said for now, treatment goes on as usual at the clinic.

"What I tell the staff, ‘if you’ve helped one person that day, you’ve done your job’," she said.

Suboxone, the medication the tribe uses for treatment, is a controlled substance because of its potential for abuse – it can deliver a high. Tribal officials said they take steps to stop diversion from happening, but deal with it on a case by case basis.

"Everybody has the ability to change, we just have to encourage and support that… we’re just the helpers for them for a short time while they’re here," Johnson said.

Gary Headbird, who is scheduled to complete the program’s treatment later this year, believes it has saved his life and wishes more people in the community would take advantage of it.

"It just reset everything like it was fine. I didn’t have the sickness anymore, didn’t have the cravings," he said. "Not only the medication, it was going there every day and having people to talk to that was in the same boat that I was."

After graduation, Headbird hopes to one day work as a counselor in the program and help other people battling addiction.

"Our community need a lot of help to get better," he said. "It’s really like a lifeline. You’re out there drowning, and they throw a lifeline to you and you grab it and they haul you on the boat… but you got to ask for help."

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Ryan Raiche can be reached by phone at 651-642-4544 or by email here.

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