State Medicaid programs are using a variety of approaches to respond to the opioid crisis, but Medicaid beneficiaries—who have been disproportionately affected by the epidemic—continue to face barriers when trying to access substance use disorder (SUD) treatment. Chapter 4 builds on analysis in the June 2017 Report to Congress on Medicaid and CHIP, which found that access to care may be impeded by factors ranging from fear about the stigma of having an SUD to a fragmented and poorly funded delivery system.
MACPAC’s review of state policies in the June 2018 report to Congress shows that only 12 states pay for the full array of clinical services to treat substance use disorders, which includes outpatient and residential treatment with varying degrees of intensity, as well as medication-assisted treatment. While states can cover many of these services—including residential treatment services in institutions for mental diseases (IMDs)—they choose not to for a variety of reasons. Moreover, eliminating the IMD exclusion would not address gaps in coverage for many services. In addition, an inadequate supply of SUD treatment facilities and low provider participation rates in Medicaid also affect access to treatment.
Although the analysis focuses on the treatment of opioid use disorder, many of the concerns described in Chapter 4 apply to treatment of other SUDs that trouble many communities, such as those associated with cocaine and methamphetamines. The chapter concludes by identifying areas for further study.
Publication Type: Reports to Congress