About one-third of Medicaid enrollees with opioid use disorder (OUD) did not receive medication as a part of their treatment.
New data from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) found that “a significant number of enrollees with opioid use disorder may not be receiving this life-saving treatment.”
The greatest disparities in medication for OUD (MOUD) use by Medicaid members are seen based on the states where members live and their ages. There are also significant differences between different racial groups and the rate of MOUD use.
“This finding suggests more effort is needed to ensure that all enrollees in need can access treatment through Medicaid,” a recently published OIG report states. “Further, if pandemic-related flexibilities end, the number of enrollees who are unable to access MOUD may be even higher in the future.”
The report calls on the Centers for Medicare & Medicaid Services (CMS) to reduce barriers to treatment, especially for underserved groups, and to work with state and federal governments to increase Medicaid enrollee’s knowledge of MOUD.
The report found that 1.5 million Medicaid members in 2021 experienced OUD, and roughly 1 million received some form of MOUD via buprenorphine (60%), methadone (33%) or naltrexone (6%).
For those who didn’t receive treatment, the report suggests that a portion of Medicaid enrollees may have received treatment on a cash-pay basis or that the form of treatment was not medically appropriate.
The gulf between the rates of MOUD use among the states spans 52 percentage points, with Illinois having the lowest rate (37%) and Rhode Island having the highest (89%).
Less than half of enrollees who experienced OUD received MOUD in 10 states.
“We found that many of these states had significantly lower MOUD use compared to other states with similar rates of opioid use disorder,” the report continues.
In the 15 states with reliable demographic data, about 84% of enrollees identified as experiencing OUD were white, while 13% were Black; the remainder were Asian, Pacific Islander, American Indian or Alaska Native.
Black enrollees experienced the lowest rate of MOUD use at 53%. White patients had the highest rate, 71%, slightly above the aggregate use rate of about 67%.
“Research suggests that people of color may face significant barriers in accessing opioid use disorder treatment, which could result in racial and ethnic disparities in MOUD utilization,” the report states. “Barriers include shortages of MOUD providers in their communities, racial discrimination in health care settings, and increased stigma surrounding substance use disorders, including opioid use disorder.”
It also highlighted the near-non-existent use of MOUD in treating those experiencing OUD at ages 18 and younger.
Separate research finds that there is serious hesitancy in the market for providers to give children medication for OUD. Only 24% of residential addiction treatment facilities offer buprenorphine to those aged 16 years and older. Buprenorphine is approved for treating OUD in youth.
“Despite increasing overdose deaths among children and adolescents, some providers may be hesitant to treat this age group with MOUD due to its limited approval for patients under the age of 18,” the report states. “Still, some enrollees may be unable to find providers that offer or specialize in pediatric MOUD treatment.”