Kim Krisberg, Public Health Watch and Stephanie Colombini, WUSF
CITRUS COUNTY, Fla. — It was laborious sufficient for Stephanie to get methadone therapy when she moved to Florida from Indiana final 12 months. The nearest clinic was nearly an hour’s drive away and she or he couldn’t drive herself. But a minimum of she didn’t have to fret about the price of care.
As a guardian with younger youngsters who was unable to discover a job after shifting, Stephanie certified for Medicaid regardless of Florida’s tight eligibility guidelines. The state insurance coverage program for individuals with low incomes or disabilities covers the methadone she wants to scale back her opioid cravings and stop withdrawal illness.
For practically a decade, methadone has helped her maintain down a job and handle her children. “Just have a normal, really normal, life,” mentioned Stephanie, 39, who requested that her final identify be withheld as a result of her two youngest youngsters don’t learn about her historical past of opioid use dysfunction or that she has been in therapy for opioid dependancy. “All the things that some people take for granted.”
So it was devastating for Stephanie when she visited her clinic in summer time 2023 and discovered she had been dropped from the state’s Medicaid rolls as this system labored to redetermine the eligibility of every enrollee. Suddenly, her methadone prescription value rather more than she might afford.
She panicked, afraid a disruption in care would set off debilitating withdrawal signs like vomiting, fever, cramps, joint ache, and tremors. “That’s the first thing I thought,” she mentioned. “I’m going to be so sick. How am I going to get up and take care of the kids?”
As of September, greater than 25 million Americans — together with 1.9 million Floridians — had misplaced Medicaid protection for the reason that expiration of federal covid-19 pandemic protections in March 2023 that had stored individuals regularly enrolled. Among them had been sufferers in therapy for opioid dependancy, similar to Stephanie, for whom a lack of protection may very well be lethal.
Research shows that, when taken as prescribed, medicines for opioid use dysfunction — similar to methadone and the same drugs, buprenorphine — can cut back harmful drug use and cut overdose fatalities by greater than half. Other studies have found the risk of overdose and dying will increase when therapy is interrupted.
It is unclear how many individuals with opioid dependancy have misplaced protection within the Medicaid disenrollment, often called the “unwinding.” But researchers at KFF, a well being info nonprofit that features KFF Health News, estimate that greater than 1 million low-income Americans rely upon the federal-state Medicaid program for lifesaving dependancy care.
At Operation PAR — a nonprofit dependancy therapy supplier from which Stephanie and 1000’s of others alongside Florida’s Gulf Coast get care — the proportion of opioid therapy sufferers with Medicaid has dropped from 44 to twenty-eight for the reason that unwinding started final 12 months, the group mentioned.
Dawn Jackson, who directs Operation PAR’s latest clinic, about an hour north of Tampa within the small Citrus County metropolis of Inverness, mentioned it has been a wrestle attempting to stretch restricted grant {dollars} to cowl the latest surge of uninsured sufferers.
“There’s been sleepless nights,” Jackson mentioned. “We’re saving lives — we’re not handing out Happy Meals here.”
Methadone and buprenorphine are thought of the gold standard of take care of opioid dependancy. The medication work by binding to the mind’s opioid receptors to dam cravings and withdrawal signs with out making an individual really feel excessive. Treatment reduces illicit drug use and the accompanying overdose danger.
However, few Americans who may gain advantage from the medicines truly obtain them: The newest federal data exhibits that in 2021 only about 1 in 5 individuals who wanted the medicines obtained them. The low numbers supply a pointy distinction to the record-high drug overdose epidemic, which killed nearly 108,000 Americans in 2022 and is driven primarily by opioids.
Zachary Sartor, a household drugs physician in Waco, Texas, who focuses on dependancy therapy, described the impact of such medicines as “nothing short of remarkable.”
“The evidence in the medical literature shows us that things like employment and quality of life overall increase with access to these medications, and that definitely bears out with what we see in the clinic,” Sartor mentioned. “That benefit just seems to grow over time as people stay on medications.”
Sartor, who works at a security web clinic, prescribes buprenorphine, and most of his sufferers are uninsured or on Medicaid. Some are among the many 2.5 million Texans who misplaced protection through the state’s unwinding, he mentioned, inflicting their out-of-pocket buprenorphine prices to abruptly rise as a lot as fourfold.
The lack of protection — which additionally cuts entry to well being care past dependancy therapy — typically requires sufferers to make dangerous trade-offs.
Sartor mentioned that may imply sufferers having to decide on between medicines to deal with their dependancy and medicines for different medical situations. “You start to see the cycle of patients having to ration their care,” he mentioned.
Many individuals who misplaced their insurance coverage within the Medicaid unwinding have since seen it reinstated. But even a quick disruption in care is severe for somebody with opioid use dysfunction, mentioned Maia Szalavitz, a journalist and an writer who writes about dependancy.
“If you want to save people’s lives and you have a lifesaving medication available, you don’t interrupt their access to health care,” Szalavitz mentioned. “They end up in withdrawal and they end up dying.”
When Stephanie misplaced her Medicaid protection final 12 months, Operation PAR was in a position to subsidize her out-of-pocket methadone prices, so she paid solely $30 every week. That was cheap sufficient for her to stay with therapy for the six months it took to revive her Medicaid protection.
But the patchwork of federal and state grants that Operation PAR makes use of to cowl uninsured sufferers doesn’t at all times meet demand, and ready lists for backed methadone therapy are usually not unusual, mentioned Jackson, who directs the clinic in Citrus County.
Even earlier than the Medicaid unwinding, about 13% of individuals youthful than 65 in Florida had been uninsured, one of many highest charges within the nation, in response to census knowledge. Florida can be one of 10 states that haven’t expanded Medicaid for low-income adults.
Jon Essenburg, chief enterprise officer at Operation PAR, mentioned a latest infusion of opioid settlement money worn out the group’s ready lists, a minimum of for now. But he mentioned settlement {dollars} — Florida expects to receive $3.2 billion over 18 years from opioid producers and distributors — are usually not a long-term answer to persistent protection gaps, which is why stabler reimbursement sources like Medicaid may help.
“Turning people away over money is the last thing we want to do,” Jackson mentioned. “But we also know that we can’t treat everybody for free.”
Stephanie is grateful she by no means needed to go with out her drugs.
“I don’t even want to think about what it would have been like if they wouldn’t have worked with me and helped me with the funding,” Stephanie mentioned. “It would have been a very dark rabbit hole, I’m afraid.”
Kim Krisberg is a contributing author for Public Health Watch and co-leads the reporting challenge The Holdouts. Stephanie Colombini is a reporter for WUSF’s Health News Florida challenge.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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