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The Purpose

The Gateway to Better Health Demonstration Project preserves access to primary and specialty healthcare services for approximately 25,000 low-income, uninsured individuals in St. Louis City and County.

Approved on July 28, 2010, by the Centers for Medicare and Medicaid Services (CMS), Gateway to Better Health provides up to $30 million annually in funding for primary and specialty care as well as other outpatient services. The program was designed to provide uninsured patients a bridge in care until they were able to enroll in health insurance coverage options available through the Affordable Care Act.

Gateway to Better Health Extended to 2015

The State of Missouri has received an extension of its successful “Gateway to Better Health” (Gateway) Pilot Program from the Centers for Medicare and Medicaid Services (CMS). Gateway provides primary, specialty and urgent care coverage to uninsured adults in St. Louis City and County, aged 19-64, through a network of community providers and is sponsored by the Missouri Department of Social Services in partnership with the St. Louis Regional Health Commission. The extension of the Pilot Program will preserve up to $30 million in annual funding for community health care in St. Louis’ urban core. These funds will assist in providing a bridge for safety net providers and uninsured patients to coverage options until Medicaid expands in Missouri.

Under the terms of the extension, Gateway will cover individuals up to 100% of the federal poverty level (FPL) beginning January 1, 2014. This is a change from the previous income limit of 133% FPL for primary care and specialty care services and up to 200% FPL for specialty care services. This change will mean that approximately 4,000 individuals currently enrolled in the Gateway program will no longer be eligible for Gateway coverage on January 1, 2014. Community health centers, RHC staff, and its partners are working to transition those individuals to other coverage options that may be available to them. For new Gateway eligibility information, please visit http://www.stlgbh.com/.

The St. Louis Regional Health Commission will continue to coordinate, monitor and report on the Demonstration Project. In its first complete year of operation (July 1, 2012-June 30, 2013), Gateway provided health coverage to more than 28,000 otherwise uninsured St. Louis area residents. Gateway has paid for nearly 47,000 primary care and dental visits; more than 150,000 medications to manage chronic conditions and diseases; and more than 28,000 specialty and diagnostic care visits. Gateway has also prevented an estimated 50,000 to 70,000 emergency department visits last year.

The funds provided by the Demonstration Project will be used to provide outpatient coverage for eligible individuals in St. Louis City and County. These funds represent about 20 percent of the total budget for community health centers operating in St. Louis. With the approval of the Demonstration Project extension, the Commission will continue working with its partners to ensure Gateway members maintain access to quality primary and specialty care services in the St. Louis region.

For more information, please contact Robert Fruend, Jr. at (314) 446-6454 x.1131.

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