Medicaid expansion has been available to Alaskans for over a month, and 93 people in the capital city have enrolled. Two-hundred and sixty-three in all of Southeast. It’s providing coverage for the uninsured. But it’s also offering increased care for those who qualify with Indian Health Service.Download AudioFor one Juneau man, that means having options to treat alcohol addiction.James Refuerzo and his family outside their home. (Photo by Elizabeth Jenkins/KTOO)James Refuerzo says he fell on hard times when he was in his 20s, and he’s still paying for it now. Back then, he didn’t think he had a drinking problem.“Maybe one time I’d overdo it. Then all a’sudden I find myself doing something I totally wouldn’t be doing if I was sober,” he said. “With my addiction sometimes I’d drink eight or 10 beers and make a dumb decision and say, ‘Hey I think I can drive.”After his third DUI, he was locked up at Lemon Creek Correctional Center. Refuerzo is the father of three small kids. He spent two years away serving his sentence and had a revelation.“Realizing, hey, this has got to stop. ‘Cause the next time I get in trouble, I’m automatically going to be in jail for five years,” Refuerzo said. “And I don’t want to do that and with my kids, something had to change and that’s when I went to Rainforest.”He knew SEARHC was another option. That’s the tribal health care organization serving Alaska Natives in Southeast. Refuerzo is Tlingit from the Wooshkeetaan Clan. So most of his medical needs are covered. But Juneau SEARHC only offers limited outpatient care for substance abuse treatment.“It’s tough just to ask for help but then when you ask for it and to be told to wait, it’s a little bit tougher.”At Rainforest Recovery Center, he says he was able to fill out a form and come back that same day. The center has a sliding-scale payment policy. There’s an overnight treatment program. Refuerzo opted to do outpatient. And he says things got better. He was meeting with a counselor regularly and talking about his problems.“When I got my job and everything I didn’t qualify for the sliding scale and I was paying 100 percent,” he said.Refuerzo only works part-time and owes Rainforest over $1,300.“It’s gone to collections now. I just got another letter saying this one is going to go to collections, too. It’s like I got to take care of it later on in life when I start making more money and decide to start fixing my credit,” he said.So he stopped going Rainforest. Then he heard he qualified for Medicaid, which pays for treatment.Bettyann Boyd, Refuerzo’s girlfriend, helped him sign up. She works at SEARHC and has been covered by Indian Health Service and Medicaid for a long as she can remember. Medicaid covers travel expenses for medical reasons and specialized care. Giving her family more opportunities.“Just the choice, the choice to have a different option to go to a private clinic, a private dental. If you’re not feeling comfortable with the IHS services,” Boyd said.And she’s glad those choices could extend to her boyfriend, Refuerzo. She’s proud of the work he’s done on himself. She’s going to counseling, too.“We’re doing really good and we been doing really good. Who knew we’d be able to live in this trailer and have a trailer and own it,” she said. “Everything just keeps going up higher and higher.”Refuerzo hasn’t heard back yet if he’s been approved for Medicaid. Some people who’ve signed up have had to wait. But after Nov. 1 new applicants will get an instant response from the Health Care Exchange that could speed up the process.When his enrollment card does come, Refuerzo says it’ll feel good to slip it in his wallet.“For once I’ll feel like I’ve got something in my life that means something material wise. … I’ve never carried an insurance card before. And each time I’ve been asked, I’ve never had insurance number in my life,” he said. “And it’s going to be nice knowing that I got Medicaid and I’m not just stuck seeing one person because that’s the only person I can see. I can seek out other opinions, other options.”He’s four months sober. But he says it’ll be nice to know he can get help when he needs it.