OIG: Opioid treatment gaps persist among Medicare, Medicaid enrollees
Enrollees in high-need areas often lack access to providers who can prescribe or dispense these medications, OIG finds.
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There are significant barriers to accessing medications for opioid use disorder (OUD) among Medicare and Medicaid beneficiaries, particularly in rural and underserved areas, with many counties lacking either medication for opioid use disorder (MOUD) or access for Medicaid beneficiaries, according to a new report from the Department of Health and Human Services' Office of Inspector General.
The report underscored the urgent need for federal action to address these gaps as the opioid crisis continues to claim lives.
OIG painted a troubling picture of disparities in access to OUD medications, such as methadone, buprenorphine, and naltrexone, which are widely recognized as effective treatments for individuals battling opioid addiction.
According to the OIG, while these medications are covered under Medicare and Medicaid, enrollees in many high-need areas – especially rural or medically underserved regions – often lack access to providers who can prescribe or dispense these medications.
WHAT'S THE IMPACT?
One of the primary issues is the shortage of healthcare providers certified to prescribe or dispense OUD medications, particularly in rural and underserved areas. Many states have seen a significant increase in opioid-related deaths, but they lack a sufficient number of providers offering medication assisted treatment (MAT), leaving vulnerable populations without viable treatment options.
This issue is compounded by regulatory and financial challenges, including low reimbursement rates for MAT services under Medicaid and Medicare, which deter providers from offering these treatments, OIG said.
The agency said addressing these workforce shortages should be a top priority for the Centers for Medicare and Medicaid Services (CMS), urging the agency to develop strategies to expand the availability of MAT services. In addition to boosting provider availability, the report recommends enhancing CMS's oversight mechanisms to ensure that states are meeting federal requirements to make OUD treatments accessible to enrollees.
The report comes at a time when CMS has already been working to address the opioid epidemic, implementing initiatives such as expanded telehealth services for OUD treatments during the COVID-19 pandemic and providing grants to states aimed at increasing access to MAT. However, the OIG's findings suggest these efforts are not enough. The report found that many states are still not providing sufficient access to OUD medications, particularly for Medicaid enrollees, and that CMS has not effectively monitored these gaps.
The lack of access to OUD medications in high-need areas disproportionately affects already vulnerable populations, including low-income individuals, racial and ethnic minorities, and people living in rural areas, the authors said, adding that these disparities exacerbate the health inequities that have long affected the healthcare system.
The report calls for immediate action to close these gaps. Among its key recommendations, the OIG urged CMS to work with states to ensure Medicaid enrollees have access to MAT services in all regions, including through the expansion of telehealth and mobile health services. It also suggested increasing federal funding for MAT providers in underserved areas to address the shortage of available prescribers.
THE LARGER TREND
The issue of access has been ongoing for some time: In 2021 OIG released a report showing that while more than one million Medicare beneficiaries had a diagnosis of opioid-use disorder in 2020, less than 16% of those beneficiaries received medication to treat their condition, accounting for fewer than one in 6 of all Medicare beneficiaries with OUD.
Last year, a JAMA Network analysis noted improvements in Medicaid coverage for substance abuse, though it found many disparities remain, especially regarding MAT access. The SUPPORT Act has driven improvements, but the growth in demand for affordable treatment continues to outpace availability, authors said.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
