Michael Darcy on LinkedIn: A Look at Substance Use Disorders (SUD) Among Medicaid Enrollees | KFF (2024)

There are a variety of efforts at the state level to address the opioid epidemic. State Medicaid programs play a particular role in the opioid epidemic, covering nearly40% of peoplewith opioid use disorder (OUD). To better understand how states are using Medicaid to help address the opioid epidemic, the 23rd annual Medicaidbudget survey, conducted by KFF and Health Management Associates (HMA) asked about the following specific strategies adopted or planned by state Medicaid officials for state fiscal years (SFYs) 2023 and 2024 to address the opioid epidemic: removing prior authorization for buprenorphine (a medication treatment for OUD), reimbursing for the initiation of buprenorphine treatment via telehealth, covering over-the-counter (OTC) Narcan, and implementing other initiatives.https://lnkd.in/ge-sSr5n

2

~Most states have removed prior authorization requirements for certain buprenorphine treatments, but other barriers remain and are complicated by the fentanyl epidemic.~Most Medicaid programs cover buprenorphine induction via telehealth, but this policy is dependent on evolving federal regulations.~At least one-third of states have or plan to add OTC Narcan to FFS Medicaid OTC formularies.~A number of states are pursuing options to add pre-release Medicaid coverage for incarcerated populations. https://lnkd.in/gUNZxxCD

2

Medication treatment is recommended for both opioid and alcohol use disorders. Yet, our new KFF analysis of 50-state Medicaid claims data shows that only 1 in 10 with w/diagnosed alcohol disorder and 6 in 10 with w/opioid disorder get medication treatment. In this analysis, we look across 6 types of SUD treatment and uncover lots of variation in treatment rates across SUD type, race/ethnicity, age, and state.There is a lot to dig into here: https://lnkd.in/e3marn6N There are some ties to this recent KFF analysis looking at facilities, including ownership and provider participation with Medicaid: https://lnkd.in/eczHgBHW

11

2 Comments

"The opioid crisis rocked America, bringing addiction and overdose into the spotlight. But it also highlighted the over-treatment of pain: Medical and dental providers alike over-prescribed opioids after procedures and for chronic conditions. Out of that over-treatment came an epidemic.In health care, over-treatment is common. Recently though, there has been a subtle shift in the opposite direction. It’s possible that “less is more” is catching on."Does this concern apply to dental care? Does a cleaning every 6 months for low-risk adults mean over-treatment. What about a scaling every quarter? We do know that 1 in 3 adults in North America have big barriers to accessing a dentist. So, for these folks, there is no treatment, not over-treatment. Medicine is self-examining its treatments and outcomes on an ongoing basis. Dental care will have to more of the same. Think #Prevora. It reduces the need for more dental care by treating the cause of dental disease.

3

The results of this study showed that "[a]mong 6374 Medicaid enrollees who met study criteria, Black enrollees were 18.2 percentage points less likely than White enrollees to start MOUD after controlling for gender, age, and Medicaid eligibility (95 % CI: -21.5 % - -14.8 %). Despite evidence that individuals with opioid use disorder (OUD) have a lower risk of all-cause and overdose mortality when using medications for OUD (MOUD) (buprenorphine, methadone, or naltrexone), only one in five people with OUD receives MOUD."https://lnkd.in/efHcN57Y#RacialEquity #Equity #RacialInequity #Inequity #MOUD #MedicationsforOpioidUseDisorder #Buprenorphine #Methadone #Naltrexone

5

https://lnkd.in/ePpjuG9jExactly the type of analysis we should all be looking for and doing internally and across health systems and ACOs.

2

A third of the 1.5 million Medicaid enrollees with opioid use disorder in 2021 did not receive medication to treat opioid use disorder (MOUD), with soaring racial health disparities also present, according to an HHS Office of Inspector General report.The biggest health disparities were based on age, OIG found, with only around one in ten (11%) individuals under age 18 with OUD getting medication for it. This compares to 70% of those ages 19 to 44, 61% of those ages 45 to 64, and 47% of those over age 65.Read more from Xtelligent Healthcare Media’s Sara Heath via PEHealthIT: https://bit.ly/46iiAJy | #HealthEquity #HealthDisparities #OpioidUseDisorder #SDoH

3

With provisions of theSUPPORT Actexpiring and undergoing reauthorization debate, and State #Medicaid programs covering nearly40% of peoplewith #opioid use disorder (OUD), this paper considers potentially useful changes: removing prior authorization for buprenorphine, telehealth reimbursem*nt for buprenorphine treatment, and covering OTC #Narcan, to name a few. #opioidcrisis #mentalhealth #addictiontreatment

4

State #Medicaid programs need to improve access to lifesaving #OpioidUseDisorder medication, finds new study, as the #opioidcrisis continues to disproportionately affect Medicaid enrollees. https://lnkd.in/gJYANgu8 #opioidaddiction #opioids #opioidoverdoses #methadone #addiction

10 Ways That States Can Improve Substance Use Treatment — Strategic investments can increase access to evidence-based care and reduce inequities>>>Use Medicaid funds strategically to expand and sustain access to evidence-based substance use prevention, treatment, and recovery support services. Direct flexible federal funds—to the fullest extent allowable—toward boosting infrastructure, prevention, harm reduction, and recovery support services. Conduct an inclusive decision-making process for allocating opioid settlement funds and prioritize funds for investments in services and infrastructure needs not covered by Medicaid or other state/federal funding streams. Incentivize and support “no wrong door” approaches to substance use care, treatment, and support services. Ensure that patients are placed in the most appropriate level of care, including nonresidential, community-based substance use treatment and recovery support services. Address substance use treatment disparities for historically marginalized groups and communities. Advance equitable access and outcomes for substance use care, treatment, and recovery support services among populations with multiple system involvement. Use data to drive effective, equitable care and outcomes. Require specialty substance use treatment providers to offer evidence-based treatments, particularly medications for opioid use disorder. Bolster the substance use prevention, treatment, and recovery support service network for children and youth.

2