Medicaid’s Role in Addressing the Opioid Epidemic
| Table 1: State Indicators of Medicaid’s Role in Addressing the Opioid Epidemic | ||||||||
| State | Opioid overdose death rate per 100,000 (2016) | Number of opioid-related overdose deaths (2016) | Medicaid coverage of MAT drugs (2017) | % of total buprenorphine spending financed by Medicaid (2016) | IMD exclusion waiver (2018) | % of adults age 19-64 with Medicaid (2016) | ||
| Prescription opioids | Heroin | Synthetic opioids, such as fentanyl | ||||||
| Alabama | 7.5 | 94 | 126 | 157 | B, N | 6% | No | 15% |
| Alaska | 12.5 | 45 | 126 | N/A | M, B, N | 34% | No | 18% |
| Arizona | 11.4 | 326 | 299 | 123 | M, B, N | 15% | Pending | 18% |
| Arkansas | 5.9 | 114 | 13 | 38 | B* | 8% | No | 15% |
| California | 4.9 | 955 | 587 | 355 | M, B, N | 16% | Approved | 22% |
| Colorado | 9.5 | 212 | 234 | 72 | M, B, N | 25% | No | 12% |
| Connecticut | 24.5 | 206 | 450 | 500 | M, B, N | 44% | No | 17% |
| Delaware | 16.9 | 31 | 56 | 79 | M, B, N | 40% | No | 20% |
| DC | 30.0 | 52 | 122 | 129 | M, B, N | 45% | No | 22% |
| Florida | 14.4 | 1,030 | 669 | 1,566 | M, B, N | 5% | No | 11% |
| Georgia | 8.8 | 455 | 226 | 277 | M, B, N | 7% | No | 8% |
| Hawaii | 5.2 | 44 | 20 | N/A | M, B, N | 25% | No | 13% |
| Idaho | 7.4 | 64 | 25 | 20 | B, N | 13% | No | 11% |
| Illinois | 15.3 | 378 | 1,040 | 907 | B* | 15% | Pending | 15% |
| Indiana | 12.6 | 231 | 297 | 304 | M, B, N | 17% | Approved | 17% |
| Iowa | 6.2 | 82 | 47 | 58 | B, N | 18% | No | 15% |
| Kansas | 5.1 | 83 | 32 | 27 | M, B, N | 8% | Pending | 9% |
| Kentucky | 23.6 | 403 | 311 | 465 | B, N | 44% | Approved | 17% |
| Louisiana | 7.7 | 111 | 149 | 89 | B, N | 8% | Approved | 19% |
| Maine | 25.2 | 132 | 55 | 199 | M, B, N | 38% | No | 17% |
| Maryland | 29.7 | 666 | 650 | 1,091 | M, B, N | 39% | Approved | 13% |
| Massachusetts | 29.7 | 267 | 630 | 1,550 | M, B, N | 49% | Approved | 21% |
| Michigan | 18.5 | 560 | 727 | 921 | M, B, N | 13% | Pending | 19% |
| Minnesota | 7.4 | 137 | 149 | 99 | M, B, N | 32% | No | 13% |
| Mississippi | 6.2 | 97 | 33 | 45 | M, B, N | 4% | No | 15% |
| Missouri | 15.9 | 231 | 380 | 441 | M, B, N | 16% | No | 10% |
| Montana | 4.2 | 12 | N/A | 14 | M, B, N | 7% | No | 17% |
| Nebraska | 2.4 | 22 | N/A | 13 | B, N | 10% | No | 8% |
| Nevada | 13.3 | 235 | 86 | 53 | M, B, N | 12% | No | 14% |
| New Hampshire | 35.8 | 69 | 34 | 363 | M, B, N | 18% | No | 8% |
| New Jersey | 16.0 | 346 | 850 | 689 | M, B, N | 22% | Approved | 14% |
| New Mexico | 17.5 | 153 | 161 | 78 | M, B, N | 30% | Pending | 28% |
| New York | 15.1 | 892 | 1,307 | 1,641 | M, B, N | 38% | No | 21% |
| North Carolina | 15.4 | 611 | 544 | 601 | M, B, N | 21% | Pending | 12% |
| North Dakota | 7.6 | 17 | 12 | 15 | B, N | 17% | No | 8% |
| Ohio | 32.9 | 785 | 1,478 | 2,296 | M, B, N | 50% | No | 19% |
| Oklahoma | 11.2 | 285 | 53 | 98 | M, B, N | 7% | No | 11% |
| Oregon | 7.6 | 128 | 114 | 43 | M, B, N | 24% | No | 21% |
| Pennsylvania | 18.5 | 634 | 926 | 1,309 | M, B, N | 29% | No | 16% |
| Rhode Island | 26.7 | 89 | 25 | 182 | M, B, N | 50% | No | 18% |
| South Carolina | 13.1 | 342 | 115 | 237 | B, N | 12% | No | 12% |
| South Dakota | 5.0 | 25 | N/A | 10 | M, B, N | 11% | No | 10% |
| Tennessee | 18.1 | 679 | 260 | 395 | B, N | 10% | No | 15% |
| Texas | 4.9 | 501 | 530 | 250 | B, N | 6% | No | 8% |
| Utah | 16.4 | 322 | 166 | 72 | M, B, N | 4% | Approved | 7% |
| Vermont | 18.4 | 23 | 45 | 53 | M, B, N | 68% | No | 17% |
| Virginia | 13.5 | 343 | 450 | 648 | M, B, N | 13% | Approved | 7% |
| Washington | 9.4 | 292 | 283 | 93 | M, B, N | 26% | No | 18% |
| West Virginia | 43.4 | 322 | 235 | 435 | B, N | 45% | Approved | 23% |
| Wisconsin | 15.8 | 328 | 389 | 288 | M, B, N | 37% | Pending | 11% |
| Wyoming | 8.7 | 26 | N/A | N/A | B, N | 19% | No | 8% |
| NOTES: The three prescriptions for opioid use disorder are methadone, buprenorphine, and naltrexone. Data on coverage of methadone and naltrexone were unavailable for Arkansas and Illinois. Indiana did not cover all three prescriptions in 2017, but reported plans to do so in 2018. Synthetic opioid deaths do not include deaths due to methadone. An IMD (institution for mental disease) is an inpatient facility with over 16 beds. | ||||||||
REFERENCES
Assistant Secretary for Planning and Evaluation, Continuing Progress on the Opioid Epidemic: The Role of the Affordable Care Act, (Washington, DC: Assistant Secretary for Planning and Evaluation, January 2017), https://aspe.hhs.gov/pdf-report/continuing-progress-opioid-epidemic-role-affordable-care-act
Center for Behavioral Health Statistics and Quality, Results from the 2016 National Survey on Drug Use and Health: Detailed Tables (Rockville, MD: Substance Abuse and Mental Health Services Administration, September 2017), https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf
Colleen M. Grogan, et al., “Survey Highlights Differences in Medicaid Coverage for Substance Use Treatment and Opioid Use Disorder Medications,” Health Affairs 35, no. 12 (Dec. 2016):2289-2296, http://content.healthaffairs.org/content/35/12/2289.full
“Health Insurance Coverage of Adults 19-64,” Kaiser Family Foundation, Accessed February 2018, https://www.kff.org/other/state-indicator/adults-19-64
IMS Institute for Healthcare Informatics, Use of Opioid Recovery Medications: Recent Evidence on State Level Buprenorphine Use and Payment Types, (Parsippany, NJ: IMS Institute for Healthcare Informatics, September 2016), https://www.imshealth.com/files/web/IMSH%20Institute/Reports/Healthcare%20Briefs/IIHI_Use_of_Opioid_
Recovery_Medications.pdf
Kaiser Family Foundation analysis of the 2016 National Survey on Drug Use and Health
MaryBeth Musumeci, Key Themes in Medicaid Section 1115 Behavioral Health Waivers (Washington, DC: Kaiser Family Foundation, November 2017), https://www.kff.org/medicaid/issue-brief/key-themes-in-medicaid-section-1115-behavioral-health-waivers/
Medicaid and CHIP Payment and Access Commission, State Policies for Behavioral Health Services Covered Under the State Plan (Washington, DC: Medicaid and CHIP Payment and Access Commission, June 2016), https://www.macpac.gov/publication/behavioral-health-state-plan-services/
National Institute on Drug Abuse, Overdose Death Rates (Bethesda: MD: National Institute on Drug Abuse, January 2017), https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
“Opioid Overdose Deaths by Race/Ethnicity,” Kaiser Family Foundation, Accessed February 2018, https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/
“Opioid Overdose Deaths by Type of Opioid,” Kaiser Family Foundation, Accessed February 2018, https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-type-of-opioid
“Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 population,” Kaiser Family Foundation, Accessed February 2018, https://www.kff.org/other/state-indicator/opioid-overdose-death-rates/
Substance Abuse and Mental Health Services Administration, Medication-Assisted Treatment (Rockville, MD: Substance Abuse and Mental Health Services Administration, November 2016), https://www.samhsa.gov/medication-assisted-treatment
Kathleen Gifford et al., Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018 (Washington, DC: Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/report/medicaid-moving-ahead-in-uncertain-times-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2017-and-2018/
