Opioid Use Disorder among Medicaid Enrollees: Snapshot of the Epidemic and State Responses
Kendal Orgera and Jennifer Tolbert. The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment. (Washington, DC: KFF), 2019. https://www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/
Medicaid and CHIP Payment and Access Commission (MACPAC). Report to Congress on Medicaid and CHIP June 2017: Chapter 2- Medicaid and the Opioid Epidemic.; 2017. https://www.macpac.gov/wp-content/uploads/2017/06/Medicaid-and-the-Opioid-Epidemic.pdf.
The brief includes the first findings from MODRN, a new initiative involving partnerships between state Medicaid agencies and universities conducting research and evaluation on the opioid epidemic and other public health issues facing their state’s Medicaid population (see Appendix for more detailed description of MODRN). To facilitate cross-state comparisons, MODRN employs a common data model to standardize estimates of OUD prevalence, treatment, and quality of care derived from state Medicaid claims and enrollment data.
KFF analysis of 2017 National Survey of Drug Use and Health.
Beth Han, Wilson M. Compton, Carlos Blanco, et al. “Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health.” Annals of Internal Medicine. 2017;167(5):293-301. https://annals.org/aim/article-abstract/2646632/prescription-opioid-use-misuse-use-disorders-u-s-adults-2015?doi=10.7326%2fM17-0865
- Virginia expanded Medicaid on January 1, 2019.
Samantha Artiga, Barbara Dipietro, and Petry Ubri. The Role of Medicaid and Impact of the Medicaid Expansion for Veterans Experiencing Homelessness. (Washington, DC: KFF), 2017. http://files.kff.org/attachment/Issue-Brief-The-Role-of-Medicaid-and-Impact-of-the-Medicaid-Expansion-for-Veterans-Experiencing-Homelessness
Brendan Saloner, Jonathan Levin, Hsien-Yen Change et al. “Changes in buprenorphine, naloxone, and opioid pain reliever prescriptions after the Affordable Care Act Medicaid Expansion.” JAMA Network Open 2018; 1(4).
Michael Linden, Sam Marullo, Curtis Bone et al. “Prisoners as Patients: The Opioid Epidemic, Medication-Assisted Treatment, and the Eighth Amendment.” J Law, Med Ethics. 2018;46:252-267.
Jesse Jannetta, Jane B, Wishner, and Rebecca Peters. Medicaid Areas of Flexibility to Provide Coverage and Care to Justice-Involved Populations. (Washington, DC: The Urban Institute): 2017. https://www.urban.org/sites/default/files/publication/88051/ohio_medicaid_1.pdf
Kathleen Gifford, Eileen Ellis, Aimee Lashbrook, et al. A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020. (Washington, DC: KFF), October 2019. https://www.kff.org/medicaid/report/a-view-from-the-states-key-medicaid-policy-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2019-and-2020/
Yaou Sheng, Peter Cunningham, Augustus White, et al. Opioid Prescribing for Medicaid Members Drops Sharply After 2016. VCU Health Behavior and Policy ARTS Evaluation, January 2019. https://hbp.vcu.edu/media/hbp/policybriefs/pdfs/HBP_ARTSIssue03_012919.pdf
These services range from outpatient treatment and counseling (ASAM 1.0), intensive outpatient treatment (ASAM 2.0), short-term residential treatment (ASAM 3.0) and inpatient detoxification (ASAM 4.0). American Society of Addiction Medicine. https://www.asam.org/resources/guidelines-and-consensus-documents/npg/complete-guideline.
MaryBeth Musumeci, Priya Chidambaram, and Kendal Orgera. State Options for Medicaid Coverage of Inpatient Behavioral Health Services. (Washington, DC: KFF), November 2019. https://www.kff.org/report-section/state-options-for-medicaid-coverage-of-inpatient-behavioral-health-services-report/
Peter Cunningham, Andrew Barnes, Yaou Sheng, et. al. Addiction and Recovery Treatment Services Access and Utilization during the First Year (April 2017 – March 2018). VCU Health Behavior and Policy ARTS Evaluation, August 2018. https://hbp.vcu.edu/media/hbp/policybriefs/pdfs/ARTSone-yearreport_8.9.18_Final.pdf
Substance Abuse and Mental Health Services Administration. Medication-Assisted Treatment (MAT) September, 2019. https://www.samhsa.gov/medication-assisted-treatment
National Institute on Drug Abuse, Medications to Treat Opioid Use Disorder. June 2018. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder
Gifford, Ellis, Lashbrook, et al, op. cit.
Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. SAMHSA. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.htm. Published September 7, 2017.
Kayla Holgash and Martha Heberlein. “Physician Acceptance of New Medicaid Patients: What Matters and What Doesn’t.” Health Affairs Blog. April 10, 2019. https://www.healthaffairs.org/do/10.1377/hblog20190401.678690/full/
For more information on ECHO, see: https://echo.unm.edu/
MaryBeth Musumeci and Jennifer Tolbert. Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act. (Washington, DC: KFF), October 2018. https://www.kff.org/medicaid/issue-brief/federal-legislation-to-address-the-opioid-crisis-medicaid-provisions-in-the-support-act/
For more information on MODRN, see: https://www.academyhealth.org/MODRN
Enrollees who age in (i.e., turn 12 at some point during the year) or age out (i.e., turn 65 at some point in the calendar year) of the age range included in the analysis are not included in the analysis for that year.
These codes included: ICD-9: 304.0x, 305.5x and ICD-10: F11.xxx.
Instead of identifying and limiting to outpatient setting, acute inpatient setting, or emergency department setting as in NQF’s specification, we use all inpatient, outpatient, and professional files in MCDM to identify beneficiaries with an OUD diagnosis.
NQF’s age criteria is 18-64 years of age for the duration of the first year during which they appear in the period. We modified the age criteria to ≥18 years of age in the beginning of the first year, and <64 at the end of the first year. In other words, we would only include beneficiaries who would be <65 years of age by the end of the second year.
Decision rules and details are available upon request.