After years of surges in drug overdose deaths, the number of fatalities has declined in recent years.
The CDC reported a 24% decline in overdose-related deaths in the 12 months ending in September 2024, compared to the previous year. Still, researchers warn that cutbacks in Medicaid coverage and programming could lead to an uptick in fatalities.
A new report published in Health Affairs outlines how cutbacks and Medicaid work requirements could turn back the clocks on combating the opioid epidemic.
“Declines in overdose deaths have coincided with rapid growth in coverage by Medicaid for substance use disorder treatment,” the article said. “Estimated Medicaid spending for opioid use disorder services was $29 billion in 2023, three times higher than spending in 2013 and nine times higher than the total of all other U.S. Department of Health and Human Services opioid-related spending in 2023. Overall, 4.9 million or 7.9 percent of Medicaid enrollees were treated for a [substance use disorder] SUD in 2021, with the highest percent of enrollees receiving treatment in Ohio, Louisiana, Maine, Vermont, and New Hampshire.”
The Affordable Care Act allowed new expansion efforts, which enabled states to cover people with incomes at or below the 138% federal poverty level, according to the article. This allowed states to take an active approach to combatting the opioid crisis.
However, deep cuts to the program could jeopardize that progress. Congress passed a budget resolution to slash the outlays overseen by the House Energy and Commerce Committee — which oversees Medicare and Medicaid spending — by $880 billion over the next decade. The spending cuts will likely disproportionately impact Medicaid.
“The size of the proposed reductions is over 2.5 times as high as all federal spending on opioid use disorder – not counting spending on treatment for other substances like stimulants, which are growing in use, and alcohol,” authors of the report said. “Congressional Republican leadership claims that its Medicaid savings will not come from cuts to benefits, yet most of the proposals under consideration would result in loss of coverage. If people losing Medicaid do not gain another type of coverage, they would likely lose access to treatment and care they are currently receiving. Several of the policy proposals under consideration specifically threaten the care that individuals with substance use disorder need.”
Researchers noted that cutting Medicaid expansion efforts would disproportionately impact individuals with a SUD. Specifically, authors said that half of the Medicaid recipients treated for opioid use disorder (OUD) were covered by the expansion program.
“Reducing the federal share of payments for the Medicaid expansion would lead, under so-called trigger laws, to immediately terminating eligibility or requiring consideration of changes in 12 states,” authors said. “In these states alone, more than 100,000 enrollees would lose access to their [medication for opioid use disorder] MOUD treatment, the gold standard treatment for fentanyl and other opioid use disorders.”
In addition to potential expansion cuts, authors of the report noted that federal work requirements, which have been discussed at the federal level, could be disastrous for SUD coverage, as many individuals with addiction face employment barriers. Still, with treatment covered by Medicaid, individuals have a greater likelihood of finding employment.
“According to a review of research, unemployment is a risk factor for SUD, and vice versa. This linkage suggests that a fundamental pathway to employment starts with treatment – a key step made possible for many by Medicaid,” authors said. “With support and coverage, recovery and employment are possible, as evidenced by more than 20 million adults reporting being in recovery.”
