Association of Medicaid and the Receipt of Medication-Assisted Treatment for Individuals with Opioid Use Disorder

Background and Purpose: The United States is facing alarming rates of opioid-use disorder (OUD) and opioid-related overdose deaths. Although medication-assisted treatment (MAT) is effective in treating OUD, its utilization is very low. Andersen’s behavioral model asserts that health insurance is one of the factors that can help people utilize health services. Previous literature supported that different types of health insurance affect health service utilization differently. This study analyzes the association between the receipt of MAT and type of health insurance among individuals with OUD, adjusting for demographic characteristics, co-occurring mental illness, and heroin use.

Methods: This cross-sectional case-control study utilized the 2019 National Survey on Drug Use and Health. The study sample included non-elderly adults (18 to 64 years old) diagnosed with OUD in the past year (n = 315). Cases were defined as individuals who met criteria for OUD in the past year and had received MAT. Controls were defined as individuals who met criteria for OUD in the past year but had not received MAT. The dependent variable was the receipt of MAT for OUD. The independent variable was health insurance (i.e., private insurance, Medicaid, other insurance, and no insurance). Covariates included age, gender, race, marital status, education, mental illness, and types of opioids used. The demographic characteristics of cases and controls are presented by univariate analyses. We also estimated the odds of receipt of MAT for individuals with OUD with different health insurances as compared to non-receipt of MAT, adjusting for all covariates.

Results: Of the 315 adults with OUD, 21.2% (n = 71) reported utilization of MAT in the past year. Of the 71 cases, 84.5% were White (n = 60), 53.5% (n = 38) had some college education, 62.0% (n = 44) used heroin, 78.9% (n = 56) had co-occurring mental illness, and 47.9% (n = 34) had Medicaid. Of the 244 controls, 66.4% were White (n = 162), 47.5% (n = 116) had some college education, 27.9% (n = 68) had used heroin, 71.7% (n = 176) had co-occurring mental illness at 78.9% (n = 56), and 30.7% (n = 75) had Medicaid. Having Medicaid resulted in 350% higher odds of receiving MAT, compared to having other insurance including private insurance. Not having insurance resulted in 30% lower odds of receiving MAT compared to having any insurance coverage. The positive association between having Medicaid and the receipt of MAT became stronger, after adjusting for all covariates.

Conclusions and Implications: This study underscores the importance of having insurance coverage for receiving MAT among adults with OUD, and highlights how Medicaid enrollment is associated with increased utilization of MAT in comparison with other types of insurance, including private insurance and not having insurance. The findings suggest that researchers should investigate why other insurance, including private insurance, is less likely to facilitate the receipt of MAT compared to Medicaid. In addition, practitioners should not only put more outreach efforts to Medicaid eligible populations, but also advocate for Medicaid expansion in states that have not expanded Medicaid.