Improving Access to Care for Medicaid Beneficiaries with Opioid Use Disorders

The opioid epidemic remains a major public health challenge in the United States, with opiate overdose continuing to account for tens of thousands of deaths annually. Medications for Opioid Use Disorder (MOUD) — Buprenorphine, Methadone, and Naltrexone — are highly effective treatments that reduce overdose risk and support recovery. Despite strong clinical evidence supporting their effectiveness, access to MOUD remains limited. Medicaid plays a central role in addressing this gap, as it covers a substantial share of individuals with opioid use disorder and finances a large portion of treatment services for opioid use disorders. In response to the opioid epidemic, policymakers have introduced a range of reforms intended to improve access to MOUD, including changes to insurance benefit design and implementation of value-based payment models. However, the effectiveness of many of these policies remains unclear. Chapters 1 and 2 of this dissertation leverage Medicaid claims data from 2015 to 2019 and exploit variation in the timing of policy changes across states to explore how Medicaid policies influence access to MOUD. Further using key informant interviews I examine how policy reforms affect treatment delivery for persons with opioid use disorders. The results from the first two essays suggest that repealing administrative ordeals such as prior authorization and implementing value-based payment reforms can improve access to MOUD. Findings from the third essay highlight the continued influence of stigma, social determinants of health, and logistical challenges in delivering MOUD, may render prior authorization repeals and value-based payment models insufficient to optimally expand MOUD access. Taken together, the findings suggest that policy reforms can play an important role in improving access to MOUD. However, policy changes must be complemented by investments in behavioral health care and alternative treatment delivery models to address barriers to addiction-related care.