Medicaid is currently the primary payer for behavioral health treatment – both mental health and addictive disorders – paying about $54 billion in 2014, or 24% of the total $220 billion of U.S. behavioral health spending (see Behavioral Health Spending & Use Accounts 1986-2014 and Medicaid: States’ Most Powerful Tool To Combat The Opioid Crisis). So, I was not surprised to read that Medicaid expansion has a big impact on access to medication-assisted opioid treatment (MAT).
In the 26 states that expanded Medicaid as of 2014, the volume of Medicaid-covered buprenorphine prescriptions for opioid use disorder treatment — a form of MAT — increased by 70% compared to non-expansion states, where Medicaid spending on buprenorphine increased by 50% (see Medicaid Expansion Linked To Increased Prescribing Of Buprenorphine To Treat Opioid Use Disorder). The numbers are striking. For example, in the expansion states, Medicaid-covered buprenorphine prescriptions increased by 132.7%. During 2011 through 2013, the rate averaged 0.98 prescriptions per 1,000 residents per quarter. During 2014, there were 2.28 prescriptions per 1,000 residents per quarter. But in the non-expansion states, Medicaid-covered buprenorphine prescriptions increased by 48.4%. During 2011 through 2013, the rate averaged 0.64 prescriptions per 1000 residents per quarter. During 2014, there were 0.95 prescriptions per 1,000 residents per quarter.
This is an illustration of the complex relationships between addiction, poverty, and eligibility for government assistance. The federal Centers for Medicare and Medicaid Services (CMS) estimates that about 12% of the Medicaid population over the age of 18 has a substance use disorder (SUD) (see Medication Assisted Treatment For Substance Use Disorders). And the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that among the 2.4 million individuals with a SUD who were eligible for Medicaid expansion, 34.1% (or 814,000) lived in a non-Medicaid expansion state (see State Participation In The Medicaid Expansion Provision Of The Affordable Care Act: Implications For Uninsured Individuals With A Behavioral Health Conditions).
But Medicaid expansion is not the only variable in access to MAT. Access and eligibility for treatment is also very uneven across the states – states have different methodologies for estimating how many the consumers in need of treatment, which treatments (and drugs) are available and preferred, and what the official “capacity” is for prescribers. For executives of provider organizations with addiction treatment programs, these data illustrated the importance of understanding the specifics of the state landscape in which your program operates. There are a few levels to keep in mind.
- What is the distribution of the population with regard to health care coverage in each state? For a look at these numbers check out The Addiction Treatment Market: $36 Billion In Spending In 2015, as well as a state-by-state look from the OPEN MINDS Behavioral Health System State Profiles.
- What are the largest health plans in each sector in the specific state? For a look at these numbers check out The 2016 OPEN MINDS Medicaid Managed Care Market Share Report and Medicare Specialty Vertical Carve-Out Plans: The 2016 OPEN MINDS Medicare SNP Market Share Report.
- What are the addiction treatment resources in the specific state? For a look at these numbers check out What Addiction Treatment Services Are Covered By State Medicaid Programs?: An OPEN MINDS Market Intelligence Report, as well as a state-by-state look from the OPEN MINDS Behavioral Health System State Profiles.
- For Medicaid in the state, what addiction treatment services are covered? For a look at these numbers check out An Update On States With Medicaid 1115 Waivers For Addiction Treatment and The Market Impact Of The New Medicaid Addiction Treatment Benefits.
- What addiction treatment medications are covered? For a look at these numbers check out Buprenorphine & Methadone – Do We Actually Need To Increase Treatment Capacity? and Access To Medication Assisted Treatment For Opioid Addiction: An OPEN MINDS Market Intelligence Report.
- For the Medicaid health plans, are addiction treatment benefits managed by the plan or by a specialty carve-out organization? For a look at these numbers check out What State Medicaid Plans Carve-Out Addiction Treatment Services?: An OPEN MINDS Market Intelligence Report and An Update On The State Medicaid Behavioral Health Carve-Out Landscape.
The answers to these questions shape the framework of developing a successful addiction treatment program marketing strategy. For more on planning services in the addiction treatment field, join us at The 2017 OPEN MINDS Strategy & Innovation Institute on June 7th for the session The Shift From Residential: The Changing Addiction Treatment Landscape, led by OPEN MINDS Senior Associate Jim Gargiulo and featuring Robert J. Budsock, MS, LCADC, President & CEO, Integrity House.