Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements.

Area of Science:

• Health Services Research
• Public Health Policy
• Substance Use Disorder Treatment

Background:

• Medicaid is the primary payer for substance use disorder (SUD) treatment in the U.S., covering over 80% of enrollees through managed care.
• State governments mandate coverage requirements for SUD treatment medications, but plan adherence is not well understood.

Purpose of the Study:

• To assess the alignment between state requirements and Medicaid managed care plan policies for substance use disorder (SUD) treatment medications.
• To examine variations in alignment based on state political leanings.

Main Methods:

• Linked national survey data from state Medicaid officials with data on 167 Medicaid managed care plans' SUD medication coverage in 2021.
• Assessed plan alignment with state coverage and prior authorization requirements, analyzing differences by state political affiliation.

Main Results:

• Many Medicaid managed care plans did not align with state requirements for covering SUD treatment medications, including prior authorization prohibitions.
• Alignment was less frequent in Republican-leaning states compared to Democratic-leaning states for most SUD medications.
• Coverage alignment was slightly higher for alcohol use disorder medications than opioid use disorder medications, with methadone being an exception.

Conclusions:

• Medicaid managed care plans in Republican-leaning states showed lower alignment with state SUD medication coverage and prior authorization requirements.
• State political leanings influenced plan adherence to SUD treatment medication policies, highlighting potential disparities in access.
• Ensuring consistent adherence to state mandates is crucial for equitable access to SUD treatment medications across all Medicaid enrollees.