Eight months after Medicaid redeterminations began, there was nearly a 3% drop in patients receiving buprenorphine to treat their opioid use disorders (OUDs).

A new JAMA study found a significant decline in medication for opioid use disorder (MOUD) in the months following Medicaid determinations.

This is despite a rise in both OUDs and an increase in buprenorphine use during the pandemic.

A total of 18.7 million people lost Medicaid coverage between the end of the Families First Coronavirus Response Act’s continuous enrollment mandate and April 2024 due to coverage unwinding.

During the redetermination process, states that utilized automatic renewal methods for enrollees saw a smaller decline in the number of patients receiving buprenorphine for MOUD treatment compared to states that did not. The largest declines in Medicaid-covered buprenorphine use were in Texas, Florida and Georgia, following high disenrollment rates in the unwinding period. California had the fewest.

Researchers note that overall, “Medicaid unwinding was associated with reduced access to buprenorphine during a critical phase of the opioid epidemic,” but that the trend “likely reflects the suspension of Medicaid eligibility redeterminations alongside policy-driven expansions in MOUD access that were national in scope, such as the March 2020 federal authorization of telemedicine-based buprenorphine inductions.”

While there was slight growth among those who turned to private insurance or paid out of pocket for MOUD coverage after the fact, there was still an overall decline in patients receiving buprenorphine, according to the study. However, both of these payment methods tend to affect medication adherence and access. Additionally, about 50% of the Medicaid decrease was not offset by other payment sources.

“Higher cost-sharing burdens are associated with shorter buprenorphine treatment retention, with one study reporting a 34% higher likelihood of discontinuation for patients in the highest vs. lowest cost-sharing quartile,” researchers wrote. “Patients paying fully out of pocket face even greater financial barriers to consistent use. Even those maintaining MOUD access after unwinding may experience coverage disruptions, leading to long-term declines in buprenorphine use and related harms.”

Other barriers to accessing buprenorphine during this time, including race and ethnicity-related causes, were not included as part of this particular study. However, past studies have observed notable disparities in access to this MOUD for treatment by race prior to Medicaid unwinding.

A new, unrelated report from the U.S. Department of Health and Human Services Office of Inspector General highlighted that while the number of providers prescribing buprenorphine for Medicare beneficiaries rose by 32% in 2023, fewer than one in five patients received a prescription for treatment—further underscoring issues with access at a national level.