The end of pandemic-era enrollment enhancements for Medicaid was associated with a rise in the number of people ending medication treatment for opioid use disorder, as well as a decrease in the number of people beginning such treatment, according to a new RAND study.
While some people who disenrolled from Medicaid may have found other methods to pay for drug treatment, the overall number of those initiating and continuing medication treatment for opioid use disorder declined in the six months after Medicaid unwinding began. The changes were greatest in states that have had the largest disenrollments.
The study tracked treatment episodes of the opioid use disorder medication buprenorphine from 2021 to 2023 as pandemic-era Medicaid enrollment protections were phased out. The study authors say the findings have relevance given the recent federal legislation expected to result in 10 million Americans losing their Medicaid health coverage by 2034.
The study is published in the Journal of Addiction Medicine.
"These findings are particularly salient at a time when policy changes are increasing uncertainty about Medicaid coverage for many individuals," said Bradley D. Stein, the study's corresponding author and a senior physician policy researcher at RAND, a nonprofit research organization. "To sustain progress the nation has made against the opioid overdose crisis, it is essential to ensure that individuals who can benefit from life-saving medication continue to receive it."
Medication treatment is the most-effective treatment for people battling addiction to fentanyl and other opioids, with buprenorphine being one commonly prescribed treatment for individuals with opioid use disorder. Medicaid covers approximately 40% of treatment for Americans with opioid use disorder.
More than 25 million Americans have disenrolled from Medicaid as a result of Medicaid unwinding -- the process in which states resumed normal Medicaid enrollment procedures after a period of continuous coverage mandated during the COVID-19 pandemic.
To examine the role that unwinding played in medication treatment for opioid use disorder, RAND researchers examined prescriptions dispensed at retail pharmacies in all 50 states and the District of Columbia to identify buprenorphine treatment episodes from Jan. 1, 2021 to Dec. 31, 2023.
About 45% of the buprenorphine treatment episodes were paid for by Medicaid, 18% by commercial insurance, 11% by Medicare, 11% by discount cards/vouchers, and 6% were cash-pay. Approximately 27% of treatment episodes were in high-unwinding states, 41% in moderate-unwinding states, and 31% in low-unwinding states.
On average, there were 3% more treatment episodes paid for by Medicaid that ended after unwinding began as compared to before unwinding. In states with the greatest unwinding, the percentage difference was more than double that in states with moderate or low levels of unwinding.
There were 2.6% fewer new treatment episodes paid for by Medicaid in the six months after unwinding compared to six months before unwinding. There was a significant 3.9% decrease in new treatment episodes paid for by Medicaid in states with the greatest unwinding, compared to a 2.4% decrease in states with moderate unwinding, and a 2% decrease in states with the smallest amount of unwinding.
Changes in treatment episodes paid for by Medicaid appear not to be completely offset by changes in reimbursement from other sources, such as individuals losing Medicaid paying out-of-pocket for buprenorphine or obtaining commercial insurance.
"These changes were associated with an increase in the number of Medicaid enrollees stopping buprenorphine treatment and a decrease in enrollees beginning it," said Rachel K. Landis, study coauthor and policy researcher at RAND. "Consistent with research on total buprenorphine fills, effects were greatest in states with the greatest Medicaid disenrollment."
Research reported in this press release was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number P50DA04635108. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support for the study was also provided by the Foundation for Opioid Response Efforts (FORE).
Another author of the study is Flora Sheng.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
