Medicaid Expansion Not Clearly Associated With Population-level Increases in Opioid Agonist Treatment

Opioid agonists buprenorphine and methadone are the standard of care for treatment of opioid use disorder, yet they are markedly underused. Access to opioid agonist medications may be limited in the US by health insurance availability and the design of health benefits. This retrospective study examined the impact of Medicaid expansion through the Affordable Care Act on statewide dispensing of buprenorphine and methadone.

  • On average, Medicaid expansion was associated with…
    • a non-significant 14% increase in methadone dispensed through opioid treatment programs.
    • a non-significant 4% increase in buprenorphine dispensed.
  • In the states with the most buprenorphine-waivered providers pre-expansion, Medicaid expansion was associated with a significant 33% increase in buprenorphine dispensed.

Comments: This study did not identify a clear association between Medicaid expansion and state-level buprenorphine or methadone dispensing. Insurance coverage may be important but insufficient to expanding opioid agonist treatment. Additional targets include improving provider supply and treatment accessibility through regulatory and health care delivery reforms.

Marc R. Larochelle, MD, MPH

Reference: Gertner AK, Robertson AG, Jones H, et al. The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints. Health Serv Res. 2020;55:383–392.

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