Medicaid's Critical Role in Opioid Use Disorder Coverage and Treatment Amid Policy Changes
National opioid overdose deaths have shown a decline since mid-2023, with provisional 2024 data indicating this trend is continuing. However, opioids were still involved in over 79,000 deaths in 2023, a figure significantly higher than pre-epidemic levels. The opioid epidemic continues to affect many Americans, with nearly 29% of adults reporting that they or a family member experienced opioid addiction in 2023. Medicaid plays a crucial role in providing coverage to nearly half (47%) of all nonelderly adults diagnosed with opioid use disorder (OUD), with higher coverage rates observed in states that expanded Medicaid under the Affordable Care Act (ACA). State Medicaid programs have also actively expanded access to treatment and medications that reduce the risk of overdose deaths.
Medicaid serves as the primary coverage source for adults receiving treatment for OUD, covering over half (56%) of individuals receiving medication for opioid use disorder (MOUD) and about two-thirds (64%) of adults receiving outpatient treatment and peer support services. Medicaid expansion under the ACA facilitates access to these treatments, with 61% of adult Medicaid enrollees diagnosed with OUD eligible through Medicaid expansion. Proposed legislative measures, including work requirements and increased eligibility determinations, could impact Medicaid eligibility and coverage stability, potentially leading to coverage losses or treatment interruptions, which research indicates significantly increases mortality risk.
Recent restructuring within Health and Human Services (HHS) includes integrating the Substance Abuse and Mental Health Services Administration (SAMHSA) into a new agency and reducing staff, potentially affecting opioid-focused programs. Budget proposals for 2026 include significant cuts to SAMHSA funding, which supports programs such as clean syringe exchanges. Data collection efforts essential for monitoring the opioid crisis, like the National Survey on Drug Use and Health (NSDUH), may also be impacted due to reported staffing changes.
The analysis of Medicaid coverage and treatment for adults with OUD uses a combination of diagnostic codes and claims data, focusing on individuals aged 19-64 with full Medicaid or CHIP coverage. Methodological criteria were applied to ensure data quality across states, resulting in the exclusion of some states from the analysis. The NSDUH data provides essential insights into substance use disorder trends, including diagnostic definitions following DSM-V criteria. This detailed data underpins the evaluation of Medicaid's role in opioid use disorder treatment and informs potential policy impacts.
In summary, while opioid overdose deaths have recently declined, the opioid epidemic remains a significant public health issue closely linked to Medicaid coverage and treatment access. Legislative and administrative changes pose potential risks to this coverage and access, highlighting the importance of monitoring policy developments and ensuring continued support for evidence-based treatments like MOUD.