Disruptions in Opioid Addiction Treatment Linked to Medicaid Changes

The ongoing transition of the Medicaid enrollment process back to pre-pandemic regulations, initiated in April 2023, may have adversely affected the treatment of individuals struggling with opioid addiction, according to a recent study conducted by researchers at the University of Michigan.

This study raises significant concerns, indicating that the disruption in care could elevate the risk of overdose and other detrimental outcomes related to opioid use disorder, particularly in states that aggressively removed individuals from Medicaid coverage during the unwinding phase in 2023. Despite a slight decline in opioid overdose fatalities, the numbers remain alarmingly high, with approximately 80,000 individuals in the United States succumbing to opioid-related causes annually.

Published in JAMA Network Open, the analysis scrutinizes the prescriptions for buprenorphine, a medication known to facilitate recovery from opioid use disorder. The study encompasses data from over 569,000 adults nationwide who were enrolled in Medicaid and received buprenorphine prior to the unwinding of Medicaid.

The researchers, led by postdoctoral fellow Joanne Constantin, Ph.D., categorized states based on the percentage decrease in Medicaid enrollment. The first group comprised states experiencing the most substantial declines, including Arkansas, Colorado, Idaho, Kansas, Montana, New Hampshire, North Dakota, Oklahoma, Texas, Utah, West Virginia, and Wyoming. The second group included states with minimal enrollment reductions, such as California, Connecticut, Delaware, Hawaii, Illinois, Maine, Massachusetts, Minnesota, Nebraska, Nevada, Virginia, and Wisconsin.

Notably, states that expanded their Medicaid programs or delayed the unwinding process were excluded from the analysis, as were individuals aged 65 and older, who are eligible for Medicare drug coverage.

Key findings from the study reveal that individuals residing in states with the largest declines in Medicaid enrollment were less likely to continue filling their buprenorphine prescriptions and more inclined to pay for the medication out-of-pocket or through private insurance. The majority of disenrollments during this period resulted from administrative complications, such as individuals failing to submit necessary income verification to their state by specified deadlines.

The analysis incorporated prescription data for all individuals in each state who utilized buprenorphine through Medicaid both before and during the early pandemic period, suggesting that the actual decrease in prescriptions may be significantly higher among those disenrolled from coverage, as evidenced by other studies examining access to care and prescriptions for individuals who lost Medicaid coverage.

Researchers emphasize the importance of investigating the consequences of the unwinding process, as it provides a unique opportunity to assess how changes in Medicaid coverage impact the accessibility of critical medications like buprenorphine, which patients often must take for extended periods to attain and sustain recovery.

Continued discussions surrounding the future of Medicaid funding are particularly pertinent, as potential cuts to federal Medicaid funding could lead to further disenrollments, similar to those experienced during the unwinding process. Such cuts could threaten access to buprenorphine for many patients.

The unwinding process aimed to revert to the eligibility determination guidelines for Medicaid that were in place before the pandemic, including annual verification of income to ensure it was at or below the federal poverty level or that individuals met other eligibility criteria.

With nearly 72 million Americans enrolled in Medicaid following the unwinding, alongside an additional 7.2 million children covered under the Children's Health Insurance Program (CHIP), the implications of these changes are significant. While ten states have yet to expand Medicaid under the Affordable Care Act, those that have extended coverage allow individuals earning up to 138% of the federal poverty level--approximately $21,000 for an individual and $36,000 for a family of three--to qualify.

Both Constantin and Kao-Ping Chua, M.D., Ph.D., the study's senior author and a member of the U-M Institute for Healthcare Policy and Innovation, stress the critical nature of this research in light of ongoing Medicaid funding debates and the potential impact on vulnerable populations seeking treatment for opioid use disorder.