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.
Researchers then compared hospital usage rates six months before and after people were enrolled — and the results were striking.
They documented a 54 percent reduction in emergency department visits and a nearly 60 percent reduction in inpatient admissions to hospitals. Three-quarters of participants were able to maintain sobriety while in the sober home program — far exceeding the typical rate for people in addiction recovery. Most, if not all, who participated are no longer homeless, organizers of the pilot program say.
Organizers estimate the cost to WellSense was up to $5,200 for each person who stayed the full six months, but that more than half of the participants progressed enough in the program to leave earlier, which meant the actual costs were much lower. By comparison, the average daily cost for a hospital room in Massachusetts is more than $3,500, according to a 2022 analysis.
“It was really dramatic,” Mary Takach, senior health policy adviser at Boston Health Care for the Homeless, said of the findings. “We are optimistic that health plans who pay treatment fees for sober homes will see health care costs decline.”
The initiative mirrors a broader trend of deploying housing as a treatment strategy for people experiencing chronic homelessness and addiction. Frequent relapses, overdoses, and joblessness often make it impossible to get into apartments of their own — making it impossible to rebuild their lives. Without a place to live, many fall deeper into addiction and cycle in and out of emergency departments dozens of times a year, at an enormous cost to health systems and insurers.
Fully 25 percent of unhoused adults in Boston reported visiting an emergency department due to substance-use-related problems in the prior year, according to a 2022 survey by the Boston Public Health Commission.
The program also comes as public health officials and nonprofits are scrambling to find fresh ways to combat the twin crises of opioid-related overdoses and surging homelessness. In Massachusetts, the homeless population increased by 53 percent, to about 29,300 last year, from just over 19,100 the year before — nearly three times the national rate, according to new data from the federal housing agency’s annual report to Congress.
The initiative was the idea of Andrew Maier, a former heroin user from North Dartmouth who spent years bouncing in and out of sober homes and treatment centers. He was intimately aware of the shortcomings of many sober homes: how many provided little more than a bed in a shared room, no services, and few staff. Many demand regular urine tests, and often kick people back to the streets if they test positive even once, he said.
Maier personally called and visited dozens of sober homes to check if they were suitable. If he saw that a house wasn’t clean, or residents were not working, then he would cross it off his list. He also knew from personal experience that the holiday season can be a lonely and perilous time for people in recovery, so he increased face-to-face outreach efforts between Thanksgiving and the New Year. And recognizing that relapse is a normal part of recovery, Maier tailored the program so that participants were allowed one failed drug test over their six-month stay.
He also organized monthly gatherings at coffee shops, in which program participants could talk through their shared experiences and struggles toward sobriety.
“We are giving them six months where they can work solely on getting themselves healthy again, because trying to stay clean while trying to find housing and a job is very, very hard,” said Maier, who serves on Boston Health Care for the Homeless Program’s advisory board.
Officials with the program said they are still analyzing the results of the pilot program, but plan to approach WellSense about funding it for a third year.
As for Malcolm-Testaverde, he said he hasn’t touched crystal meth since the day before Thanksgiving in 2023 — just hours before he walked into a sober home in Dorchester. With a stable place to sleep and the help of a recovery coach, he quickly landed a part-time job at Home Depot and returned to community college, where he is studying substance misuse counseling and human services.
“There are still moments when I’m flabbergasted that it all came together,” he said on a recent evening while walking Peppa, his two-year-old pit bull, through Dorchester.
For the first time in years, Malcolm-Testaverde has a permanent place to call home — an apartment near Franklin Park that he’s decorated with vinyl records of his favorite musicians. In an artistic homage to his journey to mental health, he hung dozens of prescription pill bottles from the plastic Christmas tree in his living room. Many of them are vital medications for his mental health that he couldn’t access while he was homeless.
Now a mental health worker at a psychiatric hospital, Malcolm-Testaverde feels confident enough about his sobriety to help others struggling with long-term addiction. Twice a week after work, he loads up his bike with sandwiches and cookies from a nearby bakery and pedals over to Mass. and Cass, a troubled area in Boston where he once stayed while homeless.. He then passes out the food to people on the street — at times fighting back tears on his return journey home on his bike.
“It’s about showing humanity,” he said. “Because for far too long, I didn’t feel recognized as a human being and I don’t want anyone else to ever feel that way.”
Chris Serres can be reached at chris.serres@globe.com. Follow him @ChrisSerres.