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'Medicaid unwinding' can be dangerous for those who need opioid addiction medications

AYESHA RASCOE, HOST:

More than 1 million Americans use Medicaid to help pay for lifesaving opioid addiction treatment, including methadone. But some people could lose Medicaid as states continue reviewing eligibility for the first time since the pandemic began. Stephanie Colombini of member station WUSF reports from Florida, where what's called the Medicaid unwinding has given some patients and providers a hard time.

STEPHANIE COLOMBINI, BYLINE: When she moved her family to Florida from Indiana last year, one thing Stephanie didn't have to worry about was paying for her methadone treatment. That's because her Medicaid covers it.

STEPHANIE: When I first moved down here, I got my insurance with no problem at all.

COLOMBINI: Stephanie asked us not to use her last name because her two youngest kids don't know she's been taking methadone to treat opioid addiction for nearly a decade. In addition to the methadone she needs to stay off illicit painkillers, Medicaid also pays for counseling. So it was devastating last summer when Stephanie showed up to her treatment clinic and learned she'd been dropped, even though she knew she still qualified.

STEPHANIE: I didn't even know I didn't have it until I was at the window one day, and they're like, well, you have a balance of, like, $400. I'm like, what?

COLOMBINI: More than 20 million Americans lost Medicaid at some point in the last year since states began reviewing eligibility again. Some, like Stephanie, eventually get their benefits back. But even a brief disruption in coverage is serious for someone taking medications for opioid use disorder says Maia Szalavitz. She's a journalist who focuses on addiction treatment.

MAIA SZALAVITZ: If you want to save people's lives and you have a lifesaving medication available, you don't interrupt their access to healthcare so that that medication becomes unavailable, they wind up in withdrawal, and they wind up dying.

COLOMBINI: Research shows, when taken as prescribed, medications like methadone can reduce opioid overdose deaths by about 50%. So Stephanie says she panicked when she lost Medicaid. She knows how debilitating opioid withdrawal can be from experience. She worried she'd start experiencing symptoms like vomiting and joint pain if she suddenly stopped taking methadone.

STEPHANIE: I'm like, oh, my gosh. I'm going to be so sick. How am I going to get up and take care of the kids? Because you can't do those things.

COLOMBINI: It would have cost her more than a hundred dollars a week to pay for it out of pocket. She couldn't afford that. The nonprofit Operation PAR runs the clinics that Stephanie goes to in Florida. It serves nearly 4,000 clients at medication treatment centers along the state's Gulf Coast. Dawn Jackson is one of the clinic directors.

DAWN JACKSON: People shouldn't have to choose between putting food on the table and getting the treatment they need to live healthy lives.

COLOMBINI: Operation PAR relies on state and federal grants to help people who can't pay for care. It was able to bring Stephanie's cost down to $30 a week. That was low enough for her to stick with treatment for the six months it took to get her Medicaid back. She's grateful she never had to go without her medicine.

STEPHANIE: All the things that some people take for granted, just waking up every day and feeling good enough to do your whole day, it's helped me a lot.

COLOMBINI: Operation PAR says about 40% of their opioid treatment patients who had Medicaid have lost it since the unwinding began. Dawn Jackson says they didn't have enough financial assistance to meet the need.

JACKSON: Turning people away over money is the last thing we want to do, but we also know that we can't treat everybody for free.

COLOMBINI: So for months, they had to place people on a wait list for aid. Extra money arrived a few months ago from Florida's lawsuits against opioid makers and pharmacies to help clear that wait list. It was a relief, but Jackson says it's not a long-term solution. She wants to see a more consistent source of funding because as the opioid crisis continues, each day without treatment could be someone's last.

For NPR News, I'm Stephanie Colombini in Tampa.

RASCOE: This story comes from NPR's partnership with KFF Health News, WUSF, and Public Health Watch. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters, WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.