Trends in Medicaid managed care benefits for opioid use disorder treatment, 2015-2019

Medicaid is the largest payor of opioid use disorder (OUD) treatment in the United States and covers a large share of Americans with OUD. The majority of Medicaid enrollees participate in Medicaid managed care organization (MMCO) plans. However, little is known regarding which OUD treatment services and medications MMCO plans cover, which utilization management policies they impose, and whether there have been changes in these treatment benefits and policies over time. This study examined trends in MMCO plan benefits and utilization management for OUD treatment from 2015 to 2019.

This descriptive study used a novel dataset on OUD treatment benefits and utilization management in all comprehensive MMCO plans active in 38 states plus the District of Columbia from 2015 to 2019 (n = 760 plan-years). We calculated the proportion of MMCO plans that provided evidence of coverage for seven OUD treatment services, three OUD treatment medications, and one opioid-overdose reversal medication. For covered treatment services and medications, we assessed whether MMCO plans imposed prior authorization requirements and quantity limits.

From 2015 to 2019, the proportion of MMCO plans reporting coverage of OUD treatment medications grew significantly. While only 18% of plans provided evidence of covering all three medications for OUD in 2015, 42% did so in 2019 (p < 0.001). Coverage for treatment services was more uneven, increasing only for residential and peer support services (from 50% to 74%, and from 35% to 45%, respectively). Despite these improvements in coverage, less than 5% of plans reported coverage for the full continuum of treatment in 2019. While prior authorization for OUD treatment medications decreased, use of quantity limits increased. Little change in use of prior authorization was observed for treatment services.

While coverage of OUD treatment medications improved, coverage of treatment services did not. Only a small minority of MMCO plans provided evidence of coverage for the full continuum of OUD treatment. Future policy is needed to address these gaps in treatment service benefits to improve OUD-related outcomes.