Medicaid insurance expansions between 2017 and 2023 sharply increased access to medication treatment for opioid use disorder in a period when fatal overdoses continued to climb, according to Rutgers Health researchers.
Their study , published in JAMA Network Open, finds that expanded Medicaid coverage saw meaningful population-level increases in the use of buprenorphine, a medication used to treat opioid use disorder.
Medicaid is a joint federal and state program that provides free or low-cost health coverage to low-income Americans. Beginning in 2014, states could decide whether to expand their Medicaid programs to cover additional residents. Forty-one states, including the District of Columbia, have adopted Medicaid expansion.
According to the U.S. Centers for Disease Control and Prevention, more than 80,000 people in the United States died from opioid overdoses from October 2023 to September 2024. Medicaid plays a central role in access to effective treatments because people with opioid use disorder are disproportionately low-income adults, meaning insurance coverage expansions can have large effects on treatment uptake.
"These results arrive at a critical moment for policymakers and health professionals," said Stephen Crystal , a coauthor of the study and the director of the Rutgers Center for Health Services Research .
Crystal, a Distinguished Research Professor at the Rutgers School of Social Work , said some earlier studies of the first Medicaid expansions "did not find major improvements in overall treatment rates, but this new analysis shows that in the current era of treatment policy, where many of the old barriers have been lifted, Medicaid expansion is not just helpful, but essential."
Using national prescription data, researchers examined how more recent Medicaid expansions affected the use of opioid use disorder treatment. They observed that expansions implemented between 2017 and 2023 happened in an environment shaped by policy changes that made treatment easier to obtain.
In recent years, federal and state policy reforms have authorized the outpatient use of medication for opioid use disorder treatment, expanded the use of telehealth and allowed more types of clinicians to prescribe opioid use disorder medication. The Researchers said these changes led to a more flexible system in which Medicaid expansion could have a broader impact on treatment access.
"These results could be incredibly important for public policymakers and state governments wrestling with the Medicaid cuts proposed under the recent H.R. 1 federal legislation ," said Nicole Siegal, lead author of the study and a postdoctoral research fellow at the O'Neill School of Public and Environmental Affairs at Indiana University. "The financial sustainability of Medicaid expansions is under threat, yet this study shows that these expansions are having the kind of widespread impact that earlier research suggested might not be possible."
This research will be presented during the 2026 AcademyHealth Annual Research Meeting, set for May 30 to June 2 in Seattle.
Coauthors include Jennifer Miles and Hillary Samples of Rutgers and Nicole Siegal, Sumedha Gupta, Kosali Simon and Matthew Aalsma of Indiana University.
