Improved Access to Treatment for Substance Use Disorder Patients Through Medicaid Fee-for-Service

A new study published in the JAMA Network reveals that Medicaid fee-for-service has made significant progress in improving access to treatment for patients with substance use disorder (SUD). The study, which covered the period from 2014 to 2021, shows a substantial increase in coverage for SUD treatment and opioid use disorder (OUD) medications. These improvements are attributed to the ongoing opioid crisis, the rising demand for affordable SUD treatment, and the mandated expansion of coverage for medications for OUD under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.

One key provision of the SUPPORT Act is the requirement for all Medicaid programs and plans to cover most FDA-approved medications for OUD, with limited exceptions. However, the act does not prohibit the use of utilization management policies. Despite these improvements, researchers highlight that the findings are highly significant, considering that only 10 states currently utilize Medicaid fee-for-service, and state Medicaid fee-for-service programs set the minimum standard for SUD treatment coverage in Medicaid MCO plans.

The University of Chicago Survey Lab conducted a comprehensive survey of Medicaid programs across the 50 states and Washington D.C., focusing on Medicaid fee-for-service coverage and utilization controls for SUD treatment. The survey, conducted in 2014, 2017, and 2021, collected data on coverage for various SUD treatment services and FDA-approved medications for treating OUD.

Increased Coverage for SUD Treatment Services and OUD Medications

The study found that over the study period, coverage for all types of SUD treatment services and OUD medications either increased or remained steady. Notably, the percentage of Medicaid fee-for-service programs covering individual and group outpatient treatment services reached 100% in 2021. Additionally, a significant number of fee-for-service programs expanded coverage for intensive outpatient treatment and detoxification (inpatient, outpatient, or both), resulting in 90% and 95% coverage, respectively.

While the percentage of Medicaid fee-for-service programs requiring copayments or deductibles increased between 2014 and 2017, the results for 2021 were mixed. Copayment requirements for individual and group outpatient treatment services decreased from 27% to 24%. Copayment requirements for intensive outpatient treatment also decreased from 27% in 2017 to 18% in 2021. However, copayments remained stagnant at 13% for short-term residential programs, while experiencing a decrease from 18% to 8% for long-term residential programs. Copayments for recovery support increased from 14% to 18%, and for detoxification, they increased from 20% to 23%.

Prior authorization requirements for treatments and medications saw a downward trend between 2014 and 2021, with the exception of long-term residential treatment, which experienced an increase in the percentage of programs requiring prior authorization. Remarkably, prior authorization for all OUD medications decreased significantly, with a two-thirds reduction in the proportion of fee-for-service programs requiring it.

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The Urgency of Addressing the Opioid Crisis

The growing attention towards opioid use disorder treatment stems from the ongoing opioid epidemic’s impact on the healthcare landscape. With more than 107,000 Americans dying from drug overdoses in 2021 alone, according to the Centers for Disease Control and Prevention, the need for effective and accessible treatment options is paramount.

Recognizing the urgency of the issue, President Biden has made addressing the opioid crisis and overdose epidemic a top priority of his administration. The National Drug Control Strategy, released in 2022, aims to expand access to treatment for addiction and overdose while targeting drug trafficking.

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