Medicaid coverage for substance abuse treatment has improved
These improvements are likely driven by the continued opioid crisis and the concurrent growth in demand for affordable SUD treatment.
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Although more needs to be done, Medicaid fee-for-service has improved throughout the years when it comes to patients with substance use disorder (SUD) being able to access treatment, according to a new study published in JAMA Network.
Coverage for SUD treatment and opioid use disorder (OUD) medications increased substantially over the study period, which ran from 2014 to 2021. These improvements, authors said, are likely driven by the continued opioid crisis, the concurrent growth in demand for affordable SUD treatment and the mandated expansion of coverage of medications for OUD under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.
As of January 2020, the SUPPORT Act required all Medicaid programs and plans to cover most FDA-approved medications for OUD, with just a few exceptions. It did not, however, prohibit the use of utilization management policies.
Researchers said these findings are "highly salient," given that just 10 states use Medicaid FFS and that state Medicaid FFS programs set the minimum standard for SUD treatment coverage in Medicaid MCO plans.
WHAT'S THE IMPACT?
The University of Chicago Survey Lab conducted an internet-based survey of Medicaid programs in the 50 states and Washington, D.C., to collect information on Medicaid FFS coverage and utilization controls for SUD treatment. The survey was conducted in 2014, 2017 and 2021.
In each wave of the survey, information was collected on coverage for various SUD treatment services such as individual and group outpatient, intensive outpatient, short-term and long-term residential, recovery support, inpatient treatment and detoxification, and outpatient detoxification services. The survey also included data on coverage for FDA-approved medications for treating OUD, including methadone and oral and injectable naltrexone and buprenorphine.
Coverage for all types of SUD treatment services and OUD medications increased or remained flat over the study period. The percentage of Medicaid FFS programs that covered individual and group outpatient treatment increased to 100% in 2021. A few FFS programs also increased coverage for intensive outpatient treatment and detoxification (inpatient, outpatient or both), resulting in 90% and 95% of programs covering these treatments, respectively.
The percentage of Medicaid FFS programs requiring copayments or deductibles increased universally between 2014 and 2017, but results were mixed in 2021. Copayment requirements decreased modestly for individual and group outpatient treatment – from 27% to 24% for both services. Copayment requirements for intensive outpatient treatment also decreased from 27% in 2017 to 18% in 2021. Use of copayments for short-term residential programs was stagnant at 13%, whereas copayments decreased for long-term residential programs from 18% to 8%. And copayments increased from 14% to 18% for recovery support and from 20% to 23% for detoxification.
Prior authorization requirements for treatments and medications were highest in 2014, and decreased in both 2017 and 2021 for nearly all services. Long-term residential treatment was the only treatment service with an increase in the percentage of programs requiring prior authorization.
Prior authorization decreased precipitously for all OUD medications. For some medications, the proportion of FFS programs requiring it decreased by two-thirds, data showed.
THE LARGER TREND
OUD treatment in particular has garnered increased attention in recent years as the opioid epidemic continues to affect the healthcare landscape. In September 2022, the U.S. Department of Health and Human Services awarded more than $1.6 billion in investments for communities throughout the country to address the addiction and overdose crisis.
According to Centers for Disease Control and Prevention data, more than 107,000 Americans died from drug overdoses in 2021, an increase of more than 15% from 2020.
In his first State of the Union address, President Biden named addressing the opioid crisis and overdose epidemic a top priority of his administration. In 2022 he released his National Drug Control Strategy to expand access to treatment for addiction and overdose, and to disrupt drug trafficking.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
