Report Shows Discrepancies in MOUD Utilization Among Medicaid Enrollees
About one-third of the 1.5 million Medicaid enrollees with opioid use disorder (OUD) in 2021 did not receive medication for opioid use disorder treatment (commonly known as MOUD), and certain demographic groups were even less likely to receive MOUD, according to a recent report from the Department of Health and Human Services (HHS) Office of Inspector General.
“Access to MOUD is crucial to reduce overdose mortality and improve the quality of life of people with opioid use disorder,” the report’s authors wrote. “Medicaid is uniquely positioned to achieve these goals given that the program is estimated to cover almost 40% of nonelderly adults with opioid use disorder.
“Although CMS (Centers for Medicare and Medicaid Services) and states have taken several steps in recent years to increase MOUD access in Medicaid, our findings demonstrate that a significant number of enrollees with opioid use disorder may not be receiving this life-saving treatment.”
The findings were based on Medicaid and Medicare claims data to determine the extent to which Medicaid enrollees with OUD received MOUD in 2021. Medicaid enrollment and eligibility data were also examined to determine variances in treatment rates among demographic groups.
In 2021, about two-thirds of Medicaid enrollees with opioid use disorder received MOUD that year, either through Medicaid or, for some dually eligible enrollees, through Medicare. Buprenorphine was the most commonly administered medication (647,832 enrollees), followed by methadone (355,024), and naltrexone (69,001).
Meanwhile, more than 510,000 eligible enrollees with OUD did not receive MOUD through Medicaid or Medicare. Researchers noted that it is possible some of the enrollees in this group may have received medication treatment through self-pay or other sources or it was determined that MOUD was not an appropriate treatment for their circumstances. Still, the authors noted, their findings suggest that more effort is needed to improve access to treatment through Medicaid for all those who are eligible and in need of services.
Demographic Discrepancies
The OIG report showed that people of color and those with a disability and/or blindness were less likely to receive MOUD. Based on data from 15 states with reliable race/ethnicity data, just 53% of Black or African American enrollees with OUD received medication treatment. Other groups, including Asians, Native Hawaiian or other Pacific Islanders, and American Indians or Alaska Natives, also had lower-than-average utilization rates.
Meanwhile, 56% of enrollees with a disability and/or blindness received MOUD compared to 67% of those without.
Utilization rates also varied widely by state. For example, while just 37% of Medicaid enrollees with OUD in Illinois received MOUD, the rate was 89% for enrollees in Rhode Island. Ten states were found to have utilization rates below 50%.
Action Items
OIG concluded its report by recommending that CMS should help states—especially those with low rates of MOUD use— identify and reduce barriers to treatment by providing technical assistance, collaborative learning opportunities, webinars, toolkits, and other resources. Efforts should also be made to increase the number of states with valid and complete race and ethnicity data.
The authors also recommended that states and federal partners dedicate resources to educating Medicaid and Children’s Health Insurance Program (CHIP) enrollees about access to MOUD, including in office-based settings.
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