Do benefits restrictions limit Medicaid acceptance in addiction treatment? Results from a national study

Andrews, Christina M.; Grogan, Colleen M.; Westlake, Melissa A.; Abraham, Amanda J.; Pollack, Harold A.; D’Aunno, Thomas; Friedmann, Peter D.

doi:10.1016/j.jsat.2018.01.010

Cited by 20 publications

(18 citation statements)

References 27 publications

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“…In the lowest tercile of states by OTP Medicaid acceptance, only 43 percent of OTPs accepted Medicaid in 2013. Even in states where Medicaid covers methadone, Medicaid programs may employ low reimbursement rates and high administrative burdens that discourage OTPs from accepting Medicaid . Our use of physician Medicaid acceptance may have been an imperfect proxy for buprenorphine provider Medicaid acceptance.…”

Section: Discussionmentioning

confidence: 99%

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Gertner

Robertson

Jones³

et al. 2020

Health Services Research

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Objective:To determine the effect of Medicaid expansion on the use of opioid agonist treatment for opioid use disorder (OUD) and to examine heterogeneous effects by provider supply and Medicaid acceptance rates. Data Sources: Yearly state-level data on methadone dispensed from opioid treatment programs (OTPs), buprenorphine dispensed from OTPs and pharmacies, number of OTPs and buprenorphine-waivered providers, and percent of OTPs and physicians accepting Medicaid. Study Design: This study used difference-in-differences models to examine the effect of Medicaid expansion on the amount of methadone and buprenorphine dispensed in states between 2006 and 2017. Interaction terms were used to estimate heterogeneous effects. Sensitivity analyses included testing the association of outcomes with Medicaid enrollment and state insurance rates.Principal Findings: The estimated effects of Medicaid expansion on buprenorphine and methadone dispensed were positive but imprecise, meaning we could not rule out negative or null effects of expansion. The estimated associations between state insurance rates and dispensed methadone and buprenorphine were centered near zero, suggesting that improvements in health coverage may not have increased OUD treatment use. The effect of Medicaid expansion was larger in the states with the most waivered providers compared to states with the fewest waivered providers. In the states with the most waivered providers, the average estimated effect of expansion on buprenorphine dispensed was 12 kg/y, enough to treat about 7500 individuals. We did not find evidence that the effect of expansion was consistently modified by OTP concentration, OTP Medicaid acceptance, or physician Medicaid acceptance. Conclusions:Gains in health coverage may not be sufficient to increase OUD treatment, even in the context of high treatment need. Provider capacity likely limited Medicaid expansion's effect on buprenorphine dispensed. Policies to increase buprenorphine providers, such as ending the waiver requirement, may be needed to ensure coverage gains translate to treatment access. K E Y W O R D S buprenorphine, Medicaid expansion, methadone, opioid use disorder 384 | Additional supporting information may be found online in the Supporting Information section. How to cite this article: Gertner AK, Robertson AG, Jones H, Powell BJ, Silberman P, Domino ME. The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints. Health Serv Res. 2020;55:383-392. https://doi.

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Section: Discussionmentioning

confidence: 99%

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Gertner

Robertson

Jones³

et al. 2020

Health Services Research

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“…State and federal policy such as Medicaid expansion and Medicaid coverage of medications have also been found to influence medication availability in the specialty treatment system [36,[88][89][90][91][92][93][94][95]. See the following studies for more detailed information on these factors: [74,76,89,92,93,[96][97][98][99].…”

Section: Ndatss: 2014-2017mentioning

confidence: 99%

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

et al. 2020

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Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.

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“…Beyond expanding insurance coverage, Medicaid and private insurers need to support long-term recovery options, eliminate barriers to effective medications, and cover a wider array of treatments (eg, peer services, vocational support). 97 Second, opioid agonist treatments must be easier to access and less expensive than illicit opioids. Buprenorphine is tightly regulated.…”

Section: Treatment Expansionmentioning

confidence: 99%

A Public Health Strategy for the Opioid Crisis

et al. 2018

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Drug overdose is now the leading cause of injury death in the United States. Most overdose fatalities involve opioids, which include prescription medication, heroin, and illicit fentanyl. Current data reveal that the overdose crisis affects all demographic groups and that overdose rates are now rising most rapidly among African Americans. We provide a public health perspective that can be used to mobilize a comprehensive local, state, and national response to the opioid crisis. We argue that framing the crisis from a public health perspective requires considering the interaction of multiple determinants, including structural factors (eg, poverty and racism), the inadequate management of pain, and poor access to addiction treatment and harmreduction services (eg, syringe services). We propose a novel ecological framework for harmful opioid use that provides multiple recommendations to improve public health and clinical practice, including improved data collection to guide resource allocation, steps to increase safer prescribing, stigma-reduction campaigns, increased spending on harm reduction and treatment, criminal justice policy reform, and regulatory changes related to controlled substances. Focusing on these opportunities provides the greatest chance of making a measured and sustained impact on overdose and related harms.

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Do benefits restrictions limit Medicaid acceptance in addiction treatment? Results from a national study

Abstract: Addiction treatment programs are more likely to accept Medicaid in states with less restrictive benefits for addiction treatment. Program ownership and technological infrastructure also play an important role in increasing Medicaid acceptance.

Cited by 20 publications

References 27 publications

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

A Public Health Strategy for the Opioid Crisis

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