@article{TEXTUAL,
      recid = {11292},
      author = {Shoulders, Angela and Andrews, Christina M. and Westlake,  Melissa A. and Abraham, Amanda J. and Grogan, Colleen M.},
      title = {Changes in Medicaid Fee-for-Service Benefit Design for  Substance Use Disorder Treatment During the Opioid Crisis,  2014 to 2021},
      journal = {JAMA Health Forum},
      address = {2023-08-11},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: Medicaid is the largest payer of substance  use disorder treatment in the US and plays a key role in  responding to the opioid epidemic. However, as recently as  2017, many state Medicaid programs still did not cover the  full continuum of clinically recommended care.&lt;/p&gt;  &lt;p&gt;Objective: To determine whether state Medicaid  fee-for-service (FFS) programs have expanded coverage and  loosened restrictions on access to substance use disorder  treatment in recent years.&lt;/p&gt; &lt;p&gt;Design, Setting, and  Participants: In 2014, 2017, and 2021, a survey on coverage  for substance use disorder treatment was conducted among  state Medicaid programs and the District of Columbia with  FFS programs. This survey was completed by Medicaid program  directors or knowledgeable staff. Data analysis was  performed in 2022.&lt;/p&gt; &lt;p&gt;Main Outcomes and Measures: The  following were calculated for a variety of substance use  disorder treatment services (individual and group  outpatient, intensive outpatient, short-term and long-term  residential, recovery support, inpatient treatment and  detoxification, and outpatient detoxification) and  medications (methadone, oral and injectable naltrexone, and  buprenorphine): (1) the percentage of Medicaid FFS programs  covering these services and medications and (2) the  percentage of Medicaid FFS programs using utilization  management policies, such as copayments, prior  authorizations, and annual maximums.&lt;/p&gt; &lt;p&gt;Results: This  study had response rates of 92% in 2014 and 2017 (47 of 51  states) and 90% in 2021 (46 of 51 states). For the 2021  wave, data are reported for the 38 non–managed care  organization plan-only states. Between 2017 and 2021,  coverage of individual and group outpatient treatment  increased to 100% of states, and use of annual maximums for  medications decreased to 3% or less (n ≤ 1). However,  important gaps in coverage persisted, particularly for more  intensive services: 10% of Medicaid FFS programs (n = 4)  did not cover intensive outpatient treatment, 13% (n = 5)  did not cover short-term residential care, and 33% (n = 13)  did not cover long-term residential care. Use of  utilization controls, such as copays, prior authorizations,  and annual maximums, decreased but continued to be  widespread.&lt;/p&gt; &lt;p&gt;Conclusions and Relevance: In this  survey study of state Medicaid FFS programs, increases in  coverage and decreases in use of utilization management  policies over time were observed for substance use disorder  treatment and medications. However, these findings suggest  that some states still lag behind and impose barriers to  treatment. Future research should work to identify the  long-term ramifications of these barriers for  patients.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11292},
}