The Purpose

The Gateway to Better Health Demonstration Project preserves access to primary and specialty healthcare services for approximately 22,000 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

The State of Missouri has been approved for 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 healthcare in St. Louis’ urban core. These funds will assist in providing a bridge for safety net providers and uninsured patients to coverage until long-term options are developed for Missouri.

The program was scheduled to end on December 31, 2017. In mid-2017, the federal government approved extending the program after December 31, 2017. Under the terms of the extension, Gateway will continue to cover individuals up to 100% of the federal poverty level (FPL) for primary, specialty and urgent care through December 31, 2017. For more information about Gateway eligibility, please visit

The RHC will continue to coordinate, monitor and report on the Demonstration Project. Since the Pilot Program began in July 2012, Gateway has annually paid for more than 100,000 medical visits and 220,000 medications for the uninsured in St. Louis. Gateway also prevents an estimated 50,000 emergency department visits each year.

The funds provided by the Demonstration Project will be used to provide outpatient coverage for eligible individuals in St. Louis City and County. 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 Angela Fleming Brown at (314) 446-6454.

Gateway Patient and Provider Surveys

The RHC contracted with Princeton Survey Research Associates International (PSRAI) to evaluate Gateway to Better Health patient and provider experience and satisfaction. During this survey process, PSRAI completed 1,202 telephone interviews with Gateway enrollees from the five Gateway funded primary care organizations.  Eighty-two percent of respondents were uninsured prior to being enrolled in Gateway, and many were not getting regular medical care.  About two-thirds of respondents (68%) have a chronic health condition such as high blood pressure, diabetes or heart disease.

Overall, Gateway enrollees believe their physical health has improved since enrolling the in Gateway, and the program is having a positive impact on their health.  Majorities report they are satisfied with the quality of the care they have received and would recommend Gateway to friends or family members.  Respondents do not feel they would be able to maintain the same level of health if the Gateway program was no longer available.

In addition to evaluating patients’ experience and satisfaction with the program, PSRAI also evaluated the providers’ experience and satisfaction with the program.  In September 2014, PRSAI conducted an online survey for Gateway providers.  Overall, providers and staff were extremely positive about the impact Gateway to Better Health has on the health of their patients, and a majority of respondents say their own job satisfaction has increased since the implementation of Gateway.

The complete reports are included below.

Gateway Patient Survey Report

Gateway Provider Survey Report