CITRUS COUNTY, Fla. — It was exhausting sufficient for Stephanie to get methadone therapy when she moved to Florida from Indiana final yr. The closest clinic was nearly an hour’s drive away and she or he couldn’t drive herself. However at the least 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 transferring, Stephanie certified for Medicaid regardless of Florida’s tight eligibility guidelines. The state insurance coverage program for folks with low incomes or disabilities covers the methadone she wants to cut back her opioid cravings and stop withdrawal illness.
For almost a decade, methadone has helped her maintain down a job and handle her youngsters. “Just have a normal, really normal, life,” stated 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 realized she had been dropped from the state’s Medicaid rolls as this system labored to redetermine the eligibility of every enrollee. Immediately, her methadone prescription value far 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 stated. “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 Individuals — together with 1.9 million Floridians — had misplaced Medicaid protection because the expiration of federal covid-19 pandemic protections in March 2023 that had stored folks frequently enrolled. Amongst them had been sufferers in therapy for opioid dependancy, reminiscent of Stephanie, for whom a lack of protection might be lethal.
Analysis reveals that, when taken as prescribed, medicines for opioid use dysfunction — reminiscent of methadone and the same drugs, buprenorphine — can cut back harmful drug use and reduce overdose fatalities by greater than half. Different research have discovered the danger of overdose and dying will increase when therapy is interrupted.
It’s unclear how many individuals with opioid dependancy have misplaced protection within the Medicaid disenrollment, generally known as the “unwinding.” However researchers at KFF, a well being data nonprofit that features KFF Well being Information, estimate that greater than 1 million low-income Individuals depend upon the federal-state Medicaid program for lifesaving dependancy care.
At Operation PAR — a nonprofit dependancy therapy supplier from which Stephanie and hundreds of others alongside Florida’s Gulf Coast get care — the share of opioid therapy sufferers with Medicaid has dropped from 44 to twenty-eight because the unwinding started final yr, the group stated.
Daybreak Jackson, who directs Operation PAR’s latest clinic, about an hour north of Tampa within the small Citrus County metropolis of Inverness, stated it has been a battle attempting to stretch restricted grant {dollars} to cowl the latest surge of uninsured sufferers.
“There’s been sleepless nights,” Jackson stated. “We’re saving lives — we’re not handing out Happy Meals here.”
Methadone and buprenorphine are thought-about the gold customary 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. Remedy reduces illicit drug use and the accompanying overdose threat.
Nevertheless, few Individuals who may gain advantage from the medicines truly obtain them: The most recent federal information reveals that in 2021 solely about 1 in 5 individuals who wanted the medicines received them. The low numbers supply a pointy distinction to the record-high drug overdose epidemic, which killed almost 108,000 Individuals in 2022 and is pushed primarily by opioids.
Zachary Sartor, a household drugs physician in Waco, Texas, who makes a speciality of 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 stated. “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 stated, 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 — usually requires sufferers to make dangerous trade-offs.
Sartor stated that may imply sufferers having to decide on between medicines to deal with their dependancy and medicines for different medical circumstances. “You start to see the cycle of patients having to ration their care,” he stated.
Many individuals who misplaced their insurance coverage within the Medicaid unwinding have since seen it reinstated. However even a short disruption in care is critical for somebody with opioid use dysfunction, stated Maia Szalavitz, a journalist and an creator 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 stated. “They end up in withdrawal and they end up dying.”
When Stephanie misplaced her Medicaid protection final yr, Operation PAR was capable of subsidize her out-of-pocket methadone prices, so she paid solely $30 per week. That was cheap sufficient for her to stay with therapy for the six months it took to revive her Medicaid protection.
However the patchwork of federal and state grants that Operation PAR makes use of to cowl uninsured sufferers doesn’t all the time meet demand, and ready lists for sponsored methadone therapy should not unusual, stated 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, based on census information. Florida can also be considered one of 10 states that haven’t expanded Medicaid for low-income adults.
Jon Essenburg, chief enterprise officer at Operation PAR, stated a latest infusion of opioid settlement cash worn out the group’s ready lists, at the least for now. However he stated settlement {dollars} — Florida expects to obtain $3.2 billion over 18 years from opioid producers and distributors — should not a long-term answer to persistent protection gaps, which is why stabler reimbursement sources like Medicaid might help.
“Turning people away over money is the last thing we want to do,” Jackson stated. “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 stated. “It would have been a very dark rabbit hole, I’m afraid.”
Kim Krisberg is a contributing author for Public Well being Watch and co-leads the reporting undertaking The Holdouts. Stephanie Colombini is a reporter for WUSF’s Well being Information Florida undertaking.
