There are few options on the North Coast for drug and alcohol addiction treatment. People without private insurance have even less access to help.

The number of treatment facilities in Clatsop County has declined over the years as the facilities have become increasingly more challenging to operate financially.

Awakenings by the Sea, a women’s only center in Seaside, and Virtue at the Pointe in Astoria, are the two inpatient rehabilitation facilities in the county. Neither accept public insurance. Clatsop Behavioral Healthcare, the county’s mental health provider, provides outpatient treatment.

There are few inpatient treatment centers in the state that accept public insurance, so people on the Oregon Health Plan — the state’s Medicaid program for low-income residents and the disabled — must look to facilities in the Portland metro area, Eugene and Hermiston.

Bridge to Pathways in St. Helens was the closest medical detox center that accepted public insurance, but it temporarily closed due to staffing challenges.

Amy Baker, the executive director of Clatsop Behavioral Healthcare, said it is difficult to find facilities that accept public insurance because the rate of reimbursement from Medicaid has long been substandard.

“The detox reimbursement rate is fine, which is why we have access to it,” she said. “It’s the residential rate, which is abysmal, which is why we don’t have access to it. It’s the few programs around the state who figured out how to operate on a dime, or maybe they’ve negotiated a higher rate with their CCO (coordinated care organization). But I think that’s the question we have to ask ourselves, is how can it be allowed to be so disparate?

“But that’s the reason why we don’t have access. I couldn’t run a residential program on that rate.”

Baker added that while private insurance has a higher rate of reimbursement, commercial carriers have become more restrictive about what they are willing to authorize, making it more difficult for providers to get paid.

Trista Boudon, an addictions counselor at Clatsop Behavioral Healthcare who leads the agency’s mobile recovery ally team, said the lack of options for people on public insurance and the uninsured is often why people die instead of getting help.

The recovery ally team, known as the “Ra-Ra Team,” is made up of four staffers who work with between 60 to 100 people at any given time. Almost all are on public insurance or are uninsured. Many are homeless.

Boudon said when someone is ready to accept treatment there is a small window to act before momentum is lost. People need to be consistent, motivated and have tools, like constant access to a phone, she said, and the process can be cumbersome.

The goal, she said, becomes keeping people alive day to day.

She said that because the only shelters in the county require people to be sober, people who are homeless and struggling with drug or alcohol abuse have an additional barrier than keeps them trapped in addiction.

“So not only are they houseless with a substance use disorder, there’s no ability to get them housing, there’s no ability to get them into residential and that’s how we’re losing them,” Boudon said. “It’s a loss-loss situation because we literally have nothing except for to go out and be with them every day, let them know that they’re seen, bring them water, take them to coffee, let them know that they’re valued and they’re worthy of trying to continue to meet their goals or improve their quality of life somehow.

“And just instill that hope in them that they should not stop trying. Because, who knows, one day it might get better.”

But she said most people in that situation become discouraged.

“And that’s heartbreaking,” Boudon said. “I’m tired of seeing people die because we don’t have enough resources to keep them alive.”