In 2015, the Centers for Medicare and Medicaid Services (CMS) reversed a longstanding policy that barred the use of federal Medicaid money for patients residing in addiction treatment and mental health facilities with more than sixteen beds.

The policy switch was intended to better help people in facilities with substance use disorder (SUD), particularly those impacted by the growing opioid use disorder (OUD) crisis.

States could apply for waivers to use federal dollars to provide patients covered by Medicaid with a full continuum of OUD care, including medication-assisted treatment (MAT).

However, these Medicaid waivers only led to a “small and nonsignificant increase” in medication-assisted OUD treatment, according to a study published in Health Affairs. 

“More substantial efforts at the federal level are required for a stronger response to the OUD crisis in Medicaid,” the study’s authors recommended.

Researchers compared enrollment and claim records of Medicaid patients in the 17 states with waivers approved by CMS between 2017 and 2019 to patient records in states without waivers. Studied patients had a diagnosis of severe OUD within the last six months and had an inpatient or residential treatment stay.

Analyzing records of over 1.7 million Medicaid patients with OUD, the authors found that methadone usage among patients in waiver states did increase between 2016 and 2020. However, the study attributed that to other changes in methadone coverage.

Meanwhile, buprenorphine and naltrexone prescriptions for Medicaid patients increased roughly equally between states with and without the federal waiver.

Waiver implementation was correlated with a slight reduction of nonfatal overdoses during a time when overall OUD overdoses were on the rise. However, the authors note that overdoses in the waiver states were already dipping compared to the non-waiver states, and concluded the reduction was insignificant.

The Health Affairs study reaches a different conclusion than earlier findings of a meaningful increase in OUD medication-assisted treatment in Louisiana and Virginia after those states secured waivers.

The authors hypothesize that the earliest waiver applicants were “ready and motivated to substantially change their Medicaid programs,” and more likely to achieve results.

The study comes amid other findings relating to treating OUD among Medicaid patients, including a report conducted by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) in September. The OIG found that Medicaid patients with OUD struggle to find medication-assisted treatment, despite changes in the law. 

Thirty-three states plus the District of Columbia have since attained Medicaid waivers to finance OUD treatment as of the end of 2023, the study noted.