Medicaid Expansion Could Improve MAT Access

With drug overdose deaths at a record high, Medicaid expansion could be key to helping more people access medication-assisted treatment (MAT) for opioid use disorder (OUD), a new study suggests.

The research comes out of Penn Medicine and was published in the journal Health Affairs this month. The findings suggest that Medicaid expansion is linked to substantial improvements in access to MAT for individuals referred to OUD treatment by criminal justice agencies.

Medicaid expansion was born out of the Affordable Care Act. It gives states the option to expand their Medicaid programs to cover more people — specifically, anyone who makes less than 138% of the federal poverty level. 


Without Medicaid expansion, many of the individuals in that category would not have access to insurance coverage, as they’d make too much money to qualify for traditional Medicaid but too little to afford most private health insurance. 

For the study, researchers reviewed 10 years worth of data from the Treatment Episode Data Set–Admissions (TEDS-A), a survey of substance use disorder (SUD) treatment admissions that Substance Abuse and Mental Health Services Administration (SAMHSA) conducts every year. Specifically, they looked at data from more than 3.2 million people struggling with OUD between 2008 and 2017.

From there, researchers zeroed in on the 21% of OUD patients who had been referred to treatment by criminal justice entities, such as the police, judges or prosecutors. The authors chose that population because it has especially high rates of OUD but faces significant access issues, the study explains. 


But some of those access issues are improving. Between 2008 and 2017, the number of OUD patients receiving MAT increased substantially. For OUD patients referred by criminal justice agencies, the percentage of people receiving medication for OUD rose from 6.3% in 2008 to 16.5% in 2017, according to the study.

Medicaid expansion made a big difference: MAT for OUD increased more in states that expanded Medicaid than in those that didn’t. (To date, 39 states have expanded their Medicaid programs.)

Overall, though, OUD patients referred to treatment by criminal justice agencies were less likely to receive MAT than patients who were referred from other sources.

“Medicaid expansion may improve evidence-based treatment for individuals with criminal justice involvement and OUD, although additional policy change outside the health care sector is likely needed to reduce persistent treatment disparities,” the study’s authors wrote.