St. Louis Pushes To Expand Medication-Assisted Treatment For The Uninsured

By Kelly Burch 08/23/18

The city's current healthcare program for the poor and uninsured does not cover mental health or addiction services.

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St. Louis officials are asking a federal agency to expand access to medication-assisted treatment under a program that provides healthcare services to uninsured individuals in the city.

The Gateway to Better Health program, which is federally funded, serves uninsured St. Louis County residents who are living below the poverty line by providing basic health services at community health centers.

Currently the program does not cover mental health or addiction services, but officials are asking the Centers for Medicare and Medicaid Services to allow the program to cover medication-assisted treatment with Suboxone and naltrexone.

“We’re the first to admit there are major gaps, and one of our major gaps is mental health and substance abuse services,” Robert Freund, CEO of the St. Louis Regional Health Commission, which operates and monitors the program, told KBIA, Missouri’s NPR affiliate. “It’s only gotten worse as the opioid crisis has really escalated here in our region.”

The Missouri Department of Health and Senior Services has asked the Centers for Medicare and Medicaid Services to reroute about $2 million currently allotted to the Gateway to Better Health program in order to allow community health centers to distribute Suboxone or naltrexone to people with opioid use disorder. The program would also require $750,000 in local matching funds, which has not been secured yet. 

The program is also seeking approval to offer counseling, psychological testing and medication-assisted treatment for alcohol use disorder. 

Freund said that if the community health centers are better able to serve people with substance use disorders, it would cut down on demand at clinics that only treat addiction, many of which are overwhelmed. 

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

Integrating care for substance use into a larger community center also allows people to seek help without judgement, said Kendra Holmes, the vice president of Affinia Healthcare, which operates community health centers in St. Louis.

“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.”

Affinia Healthcare currently has two providers trained to provide substance abuse treatment, who are paid for with grant money. Holmes said if the federal government approves the changes, Affinia would be able to offer addiction treatment services at more clinics. 

Freund acknowledged that the requested changes “would be very limited in nature but still very helpful.”

“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.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.