A federal audit released last week found that, despite changes in the law, Medicare and Medicaid enrollees may not have access to medications for opioid use disorder (OUD).
In assessing why swaths of the country have spotty or nonexistent access to the federally approved medications methadone and buprenorphine, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) noted providers “unable or unwilling to treat Medicare and Medicaid enrollees.”
Authored by Ann Maxwell, deputy inspector general for evaluations and inspections, the report surveyed all 3,143 U.S. counties. With evidence gathered from 2022, the study found that 19% of U.S. counties do not have a single opioid treatment medication provider for Medicaid or Medicare enrollees.
Over half of those counties were defined as high-need, meaning they had a drug overdose mortality rate above the 60th percentile.
Also, 36% of counties lacked a provider who, in 2022, administered buprenorphine or methadone to at least one Medicare enrollee. And 33% of counties did not administer either of these medications to at least one Medicaid patient during that year.
The report separated opioid treatment programs with office-based buprenorphine providers, and found that the latter category often did not serve Medicare and Medicaid patients. About 28% of all office-based providers treated Medicare patients, and 38% provided medication to Medicaid recipients.
Access dropped more in certain parts of the country, including Texas, Georgia and Kansas. In Texas, only 19% of office-based providers treated Medicaid enrollees.
The report follows sea changes in federal laws as well as administrative actions by the U.S. Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2020, the SUPPORT Act required all state Medicaid programs to cover opioid treatment medications. That year, Medicare also started to reimburse opioid treatment drugs.
By 2022, according to the inspector’s general report, over 137,000 office-based providers and 2,000 opioid treatment programs nationally were authorized to prescribe or administer buprenorphine.
Nonetheless, the report cited continued obstacles for providers and patients.
One such issue is the lag between claim submission and payment to the provider, especially for Medicare Advantage patients. Under Medicare Advantage, 85% of enrollees still must have CMS authorize their access to service. Prior authorization is “definitely the hindrance we hear most often,” the report read.
The report recommends that CMS geographically target Medicare patients in high-need counties. The inspector general also calls for a reassessment as to whether Medicaid reimbursement rates are “sufficient to recruit and retain” enough opioid medication providers.
CMS “supports the spirit of our recommendations and did not state whether it concurred with our recommendations,” the report stated.
