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Missouri asks to add addiction treatment to St. Louis health program for poor, uninsured

Rici Hoffarth
St. Louis Public Radio
St. Louis officials hope to add addiction treatment to the limited benefits offered by the Gateway to Better Health program for the region's uninsured people.

St. Louis health officials want to add addiction treatment to the region’s health program for low-income people without insurance.

The Missouri Department of Health and Senior Services has asked the federal Centers for Medicare and Medicaid Services to add anti-addiction drugs and services to the Gateway to Better Health program.

Substance abuse treatment is an important service to add to Gateway’s short list of benefits, said Robert Freund, CEO of the St. Louis Regional Health Commission, which operates and monitors the program.

“We’re the first to admit there are major gaps, and one of our major gaps is mental health and substance abuse services,” Freund said. “It’s only gotten worse as the opioid crisis has really escalated here in our region.”

The state needs the agency to approve any changes to the program, which is federally funded.

St. Louis health officials often call Gateway to Better Health, which covers basic services, a “bridge” to cover people until they can find comprehensive health plans. The program gives uninsured St. Louis and St. Louis County residents living below the poverty line access to low-cost care at the region’s community health centers. The program isn’t the same as insurance because it doesn’t cover services such as hospitalization or mental health care.

The request asks the federal government to redirect between $2 million and $2.5 million in Gateway to Better Health’s unused funds for the treatment program.

However, the Regional Health Commission needs $750,000 in local matching funds. Freund said the commission hasn’t found that money yet.

If federal officials allow the change, Gateway to Better Health would pay community health centers to dispense suboxone and naltrexone, two of the three recommended medications for opioid use disorder. Freund said it isn’t feasible for the program to cover methadone, the third medication, as it needs to be given at licensed distribution sites.

The program also seeks approval to cover medication that treats alcohol addiction and for counseling and psychological testing.

More than a dozen physicians at the region’s community health centers can provide addiction treatment, but the commission is working to train more. Moving some addicted patients to the community health centers could relieve pressure on overtaxed addiction-specific treatment clinics, Freund said.

“We can increase access and decrease the burden on our substance abuse providers,” he said.

The community health center Affinia Healthcare has two providers trained to provide substance abuse treatment at one of its St. Louis clinics, said Kendra Holmes, the company’s vice president. But those services are grant funded. The federal money would allow Affinia to train more addiction treatment providers and offer substance abuse services at multiple clinics, she said.

Providing addiction treatment at a primary care clinic would make seeking help less intimidating, she said.

“I think it really helps with the stigma,” Holmes said. “Because you really don’t know what the patient is coming here for. If it were a separate entity, if we called it ‘Affinia Substance Abuse Center,’ there would be a stigma.”

Freund said the addiction treatment program “would be very limited in nature but still very helpful.” If the federal government approves the changes, Gateway still wouldn’t cover long-term residential treatment.

“We’re under no illusions this would solve our access issue for substance abuse in the eastern region,” he said. “However, it’s a start and it would help.”

Follow Sarah on Twitter: @petit_smudge

Sarah is the health reporter at St. Louis Public Radio.

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