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. 2016 Dec 1;35(12):2289-2296.
doi: 10.1377/hlthaff.2016.0623.

Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications

Colleen M Grogan  1 , Christina Andrews  2 , Amanda Abraham  3 , Keith Humphreys  4 , Harold A Pollack  5 , Bikki Tran Smith  6 , Peter D Friedmann  7
Affiliations

Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications

Colleen M Grogan et al. Health Aff (Millwood). .

Abstract

The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treatment and opioid use disorder medications across the United States. Many states did not cover all levels of care required for effective substance use disorder treatment or medications required for effective opioid use disorder treatment as defined by American Society of Addiction Medicine criteria, which could result in lack of access to needed services for low-income populations.

Keywords: Access To Care; Disparities; Health Reform; Medicaid; Mental Health/Substance Abuse.

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Figures

Exhibit 1
Exhibit 1. State coverage of the American Society of Addiction Medicine (ASAM) continuum of care levels
SOURCE Authors’ analysis of National Drug Abuse Treatment System Survey data, 2013–14. NOTE The District of Columbia provides coverage across all levels of care.
Exhibit 2
Exhibit 2. State coverage across the American Society of Addiction Medicine (ASAM) continuum of care levels and opioid use disorder (OUD) medications
SOURCE Authors’ analysis of National Drug Abuse Treatment System Survey data, 2013–14. NOTE “Covered with limits” means that a state covers the service but imposes limits by either using prior authorization, annual maximum limits, or copayments and deductibles. aIncludes the District of Columbia.
Exhibit 3
Exhibit 3. State coverage of opioid use disorder medications
SOURCE Authors’ analysis of National Drug Abuse Treatment System Survey data, 2013–14. NOTE The District of Columbia provides coverage for all medications.
Exhibit 4
Exhibit 4. Types of limits imposed on substance use disorder services across the American Society of Addiction Medicine (ASAM) continuum of care levels and opioid use disorder (OUD) medications
SOURCE Authors’ analysis of National Drug Abuse Treatment System Survey data, 2013–14. aIncludes the District of Columbia.
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References

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    1. Andrews C, Grogan CM, Brennan M, Pollack HA. Lessons from Medicaid’s divergent paths on mental health and addiction services. Health Aff (Millwood) 2015;34(7):1131–1138. - PMC - PubMed

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