Funding Substance Use Treatment via Medicaid Fee-For-Service May Increase Access

Financing substance use services through Medicaid fee-for-service (FFS) may increase substance use disorder (SUD) treatment utilization in the United States, according to findings were published in JAMA Health Forum.

Researchers at Boston University conducted a cross-sectional analysis and sourced data from the Treatment Episode Data Set-Admissions (TEDS-A) database and the Kaiser Family Foundation. The primary outcome was substance use treatment service rates between 2010 and 2019 in Nebraska and Maryland, which carved in and carved out comprehensive Medicaid managed care (MMC) plans, respectively.

During the 2 years following the carve-out of substance use services from the MMC in Maryland, admissions increased by an average of 838.3 per 100,000 residents. Stratified by type of admission, ambulatory outpatient treatment increased by 969.4 per 100,000 while rehabilitation or residential services and detox admissions decreased by 101.9 and 29.3 per 100,000 residents, respectively.

During the 2 years following the carve-in of substance use services to the MMC in Nebraska, substance use service admissions decreased by a mean of 90.6 per 100,000 residents. Admissions for outpatient services decreased by 115.9 per 100,000 and detox decreased by 127.9 per 100,000 residents. No trend was observed for rehabilitation or residential facility admissions.

Using synthetic control models, substance use admissions increased by 104.4% and ambulatory outpatient services by 170.6% in Maryland. In Nebraska, the carve-in of services was associated with a -33.2% change in admissions.

A major limitation of this study is that changes to MMC coverage may steer patients to facilities that do not report treatment admissions to the databases used in this study.

Study authors concluded, “Access to substance use services is vital for reducing unnecessary morbidity and mortality among persons with SUDs. Findings from this cross-sectional study suggest that changes between FFS vs MMC coverage for Medicaid-financed SUD services can result in significant changes in treatment utilization. Carving out services may be associated with increases in SUD treatment utilization but with heterogeneous effects across states and treatment types.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.