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Effects Of Medicaid Waivers On Use Of Medications For Opioid Use Disorder And Nonfatal Overdoses In 17 States
Stephan Lindner1, Kyle Hart2, Brynna Manibusan3
1Stephan Lindner (lindners@ohsu.edu), Oregon Health & Science University, Portland, Oregon.
Health Affairs (Project Hope)
|November 4, 2024
Summary
Medicaid waivers for mental health facilities did not improve overall opioid use disorder treatment or reduce overdoses. However, waivers moderately increased medication treatment for severe opioid use disorder cases.
Area of Science:
- Health Services Research
- Public Health Policy
- Substance Use Disorder Treatment
Background:
- Federal policy historically restricted Medicaid funding for Institutions for Mental Diseases (IMDs).
- Section 1115 waivers, introduced in 2015, allow federal funding for IMD services, often tied to substance use disorder treatment improvements.
- Opioid Use Disorder (OUD) remains a significant public health challenge, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the impact of Section 1115 Medicaid waivers on medication treatment for OUD and nonfatal overdose rates.
- To compare outcomes in states with and without waivers approved between 2017-2019.
Main Methods:
- Analysis of Medicaid data from 2016-2020.
- Comparison of 17 states with approved waivers against 18 states without waivers.
- Examination of changes in medication for OUD (MOUD) prescribing and nonfatal overdose rates.
Main Results:
- Waiver implementation showed no association with overall improvements in MOUD, buprenorphine, or naltrexone prescribing.
- No significant reduction in nonfatal overdose rates was observed among Medicaid enrollees with OUD.
- A modest increase in methadone use (2.3 percentage points) and any MOUD (3.7 percentage points) was noted for severe OUD cases with inpatient/residential stays.
Conclusions:
- Section 1115 waivers implemented during 2017-2019 were not linked to widespread improvements in MOUD or reductions in nonfatal overdoses for Medicaid enrollees with OUD.
- Waivers may offer a moderate benefit for medication treatment accessibility among individuals with severe OUD requiring inpatient or residential care.
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