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Over the last decade, changes to Medicaid policies have increased access to opioid recovery medications.
These specialized medications for opioid use disorder (MOUD) are thought to be the gold standard of care. But the provision of MOUD treatment has so far been largely confined to new treatment facilities and has yet to be rolled out in many older programs.
A New Standard in Medicaid-Funded Opioid Treatment
A new study in Health Affairs, by Yale School of Public Health (YSPH) researchers, reveals that nearly 90% of the expansion in Medicaid funded addiction recovery services was from new treatment facilities rather than previously existing centers instituting changes in their practices.
Tamara Beetham led the research as part of her YSPH PhD dissertation and found the results “both an interesting and surprising result. The modernization driven by turnover, rather than changes within existing organizations, may also apply to other types of services where strong cultural beliefs may not be consistent with clinical guidelines.”
Policymakers striving to improve access to quality care and addiction treatment may glean important insights from the research findings. The results emphasize the need for older facilities to invest in workforce training and technology so they can embrace modern billing and up-to-date medication treatment practices.
Incentivizing Policy Change
For many individuals, Medicaid coverage can mean the difference between receiving evidence based treatment or going without care altogether.
Beetham’s study used data from between 2012 and 2022 and pulled from over 3,000 inpatient treatment facilities. The researchers specifically noted how facilities responded to the 2015 Medicaid waiver plan that offered Medicaid reimbursement for addiction treatment when the clinicians prescribed medications such as methadone and buprenorphine for opioid use disorder. The medications have proven to reduce overdose deaths.
A 1965 rule had excluded Medicaid reimbursement for larger addiction and psychiatric centers.
Facilities in six states adopted the waiver policy within four years of the change. These facilities were 26% more likely to accept Medicaid patients and offer MOUD than the facilities in 19 control states that didn’t offer waivers. Clients seeking addiction treatment in the six states had more opportunities to receive proven addiction treatments.
Further study of the results revealed that 89% of care improvement was due to facility turnover. The states that adopted the waivers saw that new facilities were more likely to provide medication treatment than those entering states without the waiver.
The existing treatment facilities that didn’t offer medications were likely to leave the field. In looking at continuously operating treatment centers, although Medicaid participation grew, MOUD availability did not.
While policy changes increased Medicaid participation, many long standing facilities still do not offer MOUD which leaves patients with fewer affordable treatment options.
According to the study, “Supporting established facilities in adopting MOUD through education and training and incentivizing new providers already aligned with best practices to enter, could accelerate improvements in treatment quality.”
Researchers speculate that the cost and stigma associated with MOUD, and other obstacles to providing MOUD may have dissuaded existing providers from utilizing the waiver policy.
Expanding Medicaid Coverage for Opioid Recovery Medications
Thirty-five states have some form of reimbursement policy, known as Medicaid Section 1115 “Institutions for Mental Diseases” waivers for substance use disorder. Congress is currently debating whether to make Medicaid reimbursement for residential addiction recovery and MOUD services permanent, since the programs require renewal.
Most policymakers support increased treatment access but making the program permanent is costly and thereby controversial. According to the Congressional Budget Office, if reimbursement becomes official policy, federal Medicaid spending would increase by approximately $7.7 billion over 10 years.
No matter the actions of Congress, overdose deaths and illegal drug use threaten millions of American lives. In the United States, overdose deaths have increased more than fivefold in recent decades.
Only about 10% of people with substance use disorders get treatment. For individuals who do receive treatment, studies show that only one in ten treatment plans include MOUD. And this lack of access to evidence-based treatment, including critical medications, is claiming lives.
Explore Medicaid & Low Cost Opioid Treatment Near You
If you’re struggling with opioid addiction and worried about the cost of treatment, help is available. You can compare medication assisted treatment programs near you, including rehab centers that accept Medicaid, Medicare, or offer low cost payment options.
Recovery doesn’t have to be out of reach. Find affordable treatment options today or call
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