A local sober housing program funded by health insurer helps people recover from addiction

Fifteen years of taking crystal methamphetamine battered Rosario Malcolm-Testaverde’s mind. He heard hallucinatory voices multiple times a day and suffered bouts of paranoia so severe that he sometimes was convinced the FBI was following him. He bounced in and out of hospital emergency departments seven times, racking up more than $200,000 in medical expenses.

For much of this period, he slept in homeless shelters or on the streets, which contributed to his paranoia and made it impossible to stay on medications that calmed his anxiety.

Then Malcolm-Testaverde, 35, learned of an innovative new program through his insurer that would cover the cost of his housing for six months — provided he stay abstinent. For the first time in memory, he could sleep without fear that someone would roust him at night and steal his few belongings, including his medications.

“It felt like I could breathe again, and finally face the world with a clear mind,” he said.

Malcolm-Testaverde is among 108 people with long-term addictions who had the good fortune to participate in a novel experiment in health care — one that illuminates the interdependence between housing and health.

In 2022, clinicians at the Boston Health Care for the Homeless Program, a pioneering nonprofit that serves some 11,000 people a year at 30 clinics, set out to answer a couple of basic questions. Could a health insurer be persuaded to cover the cost of sober living — often a vital step on a person’s path to recovery after years of drug use? And if so, would the investment result in cost savings for the insurer by reducing costly hospitalizations?

What they found after two years is that even a modest investment in short-term housing can result in dramatic improvements in the health of people with histories of substance use — as well as significant cost savings for health insurance plans.

Social workers at Boston Health Care for the Homeless identified dozens of people in Greater Boston who were either homeless or incarcerated who had been hospitalized for substance use-related problems. The nonprofit then teamed up with Boston Medical Center’s insurer, WellSense Health Plan, which offered to cover the monthly cost of sober living (ranging from $800 to $1,200) for participants for six months, after which time they can stay in the homes but must pay the rent. Participants would also have access to trained addiction specialists (known as recovery navigators) who could help them find work, counseling, and other support services.