Real estate broker Mike Griesser decided to open a drug treatment center near where he grew up in Carroll County five years ago, but he has yet to welcome a client.

In 2020, he bought a two-story apartment building and began renovating it into a place where men struggling with drug and alcohol use can live together, receive counseling and learn life skills. He was driven to this work after seeing friends die from drug overdoses, losing his father to complications from long-term alcoholism, and entering recovery for his own addiction to prescription pain pills and heroin.

Now he has three furnished apartment units with twin beds, dining sets and picture frames waiting to be filled by patients. The residential treatment center will be called “The Reprieve.”

The center is nearly ready to start enrolling patients, Griesser said. But it has been in limbo for more than seven months while waiting for the Maryland Department of Health to approve its license, with no end in sight and almost no communication from regulators.

The operators of The Reprieve are among many addiction and mental health treatment providers — both prospective and established — who have said delays in the state’s bureaucratic machinery are hindering their ability to help Marylanders in the midst of an overdose crisis.

“It’s incredibly frustrating,” said Melissa McCarthy, Griesser’s managing partner. The state requires a staff roster as part of the application, so McCarthy has had to offer people jobs without a start date — some of whom have since pulled out. And every month that passes is another $15,000 spent on keeping the empty building open, Griesser said.

There are some other recovery programs in the county, McCarthy said, but typically “very few” open beds. For people seeking help, “waiting is a death sentence,” said McCarthy, who once struggled with alcohol use before she went into treatment and began working in the behavioral health field.

Last year, state health officials said they began rooting out suspected Medicaid fraud, waste and abuse among providers after seeing an alarming growth in some types of treatment.

On July 1 — the same day McCarthy said she submitted The Reprieve’s license application — the state temporarily stopped allowing certain types of new providers to enroll in Medicaid. However, providers of many other types also say they are feeling the effects of the state’s heightened scrutiny.

License applications and renewals, which once typically took less than 30 days to process, may now take many months, according to providers interviewed by The Banner. That has had a chilling effect on those seeking to open or expand services as Maryland continues to grapple with drug overdoses, which have killed more than 12,000 residents since 2020, according to state data.

In December, an investigation by The Baltimore Banner and The New York Times revealed that state health officials have struggled to regulate treatment programs and barely vetted a flood of new operators. As a result, providers who used unscrupulous practices joined the treatment system, diverting patients from longstanding companies.

All providers interviewed by The Banner said they support the state’s efforts to improve oversight. But some said it should not come at a cost to providers who are following the law.

“There are a lot of bad actors out there, in it for the money,” said Tom Bond, founder and CEO of Summit Maryland, which has six residential treatment centers across the state and has experienced delays in trying to open others. “I’m here to provide the missing pieces in care, and do it right. When some of us are doing it right, there should be a process for preferred vendors.”

While there are some areas that have been flooded with programs, there are still some “recovery deserts” that could benefit from more services, he said.

Chase Cook, a spokesman for the health department, said in a statement that officials continue to review “completed applications in the order in which completed applications are received. All applications undergo a rigorous review process.”

Cook also said licensing goes through several phases of review and “timelines will vary based upon whether the provider has submitted a complete application for consideration.”

He did not answer questions about how many addiction and mental health licenses the state is trying to process and how long, on average, it is taking for a license to be approved.

Recently, the state announced a new online license application that is replacing the old paper-based process that providers have described as cumbersome and inefficient.

In Cockeysville, another treatment center sits empty while awaiting license approval. Owner Raquel Johnson, a West Baltimore native, hopes to use space outfitted with plush pillows for meditation circles and a cedar-scented candle to provide mental health and addiction counseling services, with a special focus on law enforcement officers who experience high levels of stress and trauma.

Johnson and her colleagues have been working on preparing the office for almost two years. She used much of her life savings to get started with the clinic and can only do pro bono work there, including meditation sessions and workshops, for the time being. She said she may have to give up the space when her lease ends in June, if she is still waiting for state approval then.

Johnson said “there just has to be a better process” because right now it seems like she is being “penalized for others’ mistakes.”

Another issue putting addiction and mental health service programs under pressure has been the rocky rollout of a Medicaid billing system under a new state contractor, which launched at the end of last year. Nearly 1 in 4 Marylanders get their health insurance through Medicaid, which covers low-income individuals and people with disabilities.

Many providers said they haven’t been paid or only partially paid for services. Cook said the contractor, Carelon, started issuing provider payments Jan. 6. More payments will be made as providers “adjust to the new system,” he said.

Jamie Harrell, co-owner of Allium Behavioral Services LLC, an intensive autism service provider in Baltimore County, said after years of dysfunction under the previous Medicaid payment vendor, she was hopeful. But many claims have been delayed or improperly denied, she said. If this continues, she feared her company would not be able to continue to provide services to clients.

“Some of our patients come every day, or 30 hours a week,” she said. “For them to miss regular therapy could mean not meeting their goals, regression in language skills or maybe they lose a skill we taught them, like learning how to brush their teeth and go to the bathroom by themselves.”