Medicaid health home design and buprenorphine receipt, 2009-2020

In the midst of an escalating opioid epidemic, innovative models of care are critical to expand access to opioid use disorder treatment. The Medicaid health home program, which costs the nation $1 billion annually, is intended to improve identification and treatment for enrollees with complex chronic conditions, including opioid use disorder. In this study, we assess the association of state-level Medicaid health home policies related to substance use disorder screening and health home eligibility with trends in prescriptions for buprenorphine, a medication that dramatically reduces risk of opioid-related overdose and mortality.

We use Medicaid data on buprenorphine prescriptions from 2009 to 2020 and a difference in differences methodology accounting for variation in treatment timing. Our treatment groups are states that require health homes to screen for substance use disorder and states that had at least one health home that has substance use disorder as a qualifying condition.

We find no significant difference in rates of buprenorphine prescriptions filled among states that require screening for substance use disorder and those that do not. We also do not find significant differences in buprenorphine prescriptions between states that designate substance use disorder as a qualifying condition for health home participation and those that do not.

Health home policies intended to reach opioid use disorder patients are not increasing buprenorphine receipt, which is one key measure of opioid use disorder treatment. State Medicaid programs should assess strategies to enhance health home performance in facilitating access opioid use disorder treatment.