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Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures,
Tamara Beetham1, Helen Newton2, Chima D Ndumele3
1Tamara Beetham (tamara_beetham@brown.edu), Brown University, Providence, Rhode Island.
Health Affairs (Project Hope)
|September 2, 2025
Summary
Medicaid waivers expanded access to medications for opioid use disorder (MOUD) in residential addiction treatment. Facility entry and exit significantly drove these improvements, highlighting policy acceleration effects.
Area of Science:
- Health Services Research
- Public Health Policy
- Substance Use Disorder Treatment
Background:
- Medicaid Section 1115 waivers, starting in 2015, allowed states to use restricted funds for residential addiction treatment.
- These waivers introduced new requirements for accessing these funds, impacting treatment availability.
Purpose of the Study:
- To examine changes in Medicaid patients' access to medications for opioid use disorder (MOUD) in residential addiction treatment facilities.
- To assess the influence of facility turnover on MOUD access following the implementation of Medicaid Section 1115 waivers.
Main Methods:
- Utilized facility-level survey data.
- Employed a quasi-experimental difference-in-differences framework.
- Analyzed data from 2012-2022, comparing intervention states with control states.
Main Results:
- Four years post-waiver implementation, facilities in intervention states were 26 percentage points more likely to accept Medicaid and offer MOUD.
- Facility entry and exit accounted for 89% of this increase; new facilities offered MOUD, while non-MOUD facilities exited.
- Continuously operating facilities saw improved Medicaid participation but not MOUD availability.
Conclusions:
- Provider entry and exit dynamics are crucial for accelerating the impact of health policy changes.
- Medicaid waivers can reshape the addiction treatment landscape, influencing the availability of MOUD.
- Targeted policies can leverage market dynamics to improve access to evidence-based treatments.
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