The article, “Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone,” has been published in SAj.
In this commentary, the authors state that West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia’s nine opioid treatment programs (OTPs) for the first time.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“Understanding utilization of methadone among enrollees who received Medicaid-covered methadone for the first time following implementation of West Virginia’s policy change is important to inform future policy decisions addressing disparities in access to MOUD. In West Virginia, Medicaid represented the first major source of public funding for OTP services—federal block grants had previously not covered OTP services. Thus, many people covered by Medicaid would likely have either been new to methadone treatment or have been self-paying for methadone treatment prior to the waiver, given there was no coverage of OTP services through Medicaid or Medicare prior to 2018 and 2020, respectively, though this has not been explored. It is also unknown whether Medicaid coverage of OTP services would have different impacts for those already recognized as needing treatment (e.g., enrolled with an OUD diagnosis) compared to those without. Additionally, while expanding Medicaid coverage of OTP services removed the cost barrier, prior studies have identified that distance from an OTP reduces methadone use and treatment duration, and there are wide disparities in access to OTPs across the United States, particularly in nonmetropolitan areas. To that end, we also examine whether these known barriers (i.e., travel distance and residing in a nonmetropolitan area) impacted methadone initiation and treatment duration following Medicaid coverage of methadone treatment.”
“The implementation of the IMD waiver may have been associated with an influx of enrollees. Many individuals who initiated treatment with Medicaid-covered methadone had no prior diagnosis of OUD or prior Medicaid enrollment in our observation period and potentially were existing uninsured OTP patients, underscoring that Medicaid coverage of methadone may bring underserved populations to the program. At minimum, Medicaid coverage of methadone reduces affordability barriers to OTP services for patients who otherwise were not receiving MOUD. Still, methadone patients in West Virginia Medicaid frequently traveled over 20 miles to an OTP, suggesting that the state needs greater methadone availability.”