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Fewer Addiction Treatment Facilities in States with Medicaid Work Requirements

MedicalResearch.com Interview with:
Paul Christine, MD, PhD

University of Michigan

MedicalResearch.com: What is the background for this study?

Response: In an effort to increase employment and “community engagement” among Medicaid enrollees, several states are seeking to implement new Medicaid work requirements.

While many proposals make exemptions for individuals with substance use disorders, some require active treatment to qualify for an exemption and maintain Medicaid eligibility. Since many enrollees with substance use disorder would thus need to access treatment to maintain coverage, we sought to quantify the availability of treatment resources in states with and without Medicaid work requirements.

MedicalResearch.com: What are the main findings?

Response: We found that, compared to states without Medicaid work requirements, states with approved work requirements had:

1) Higher overall drug overdose deaths (27.4 vs 22.5) and opioid overdose deaths (20.3 vs 15.8) per 100,000 population

2) A lower proportion of addiction treatment facilities offering formal opioid treatment programs (1.8% vs 3.5%) or evidence-based medications for opioid use disorder (5.1% vs 8.3%) per 100 opioid overdose deaths, and

3) Fewer medical providers who are licensed to prescribe buprenorphine (14.8 vs 27.8) for opioid use disorder per 100 opioid overdose deaths. 

MedicalResearch.com: What should readers take away from your report?

Response: Currently, states with approved Medicaid work requirement waivers have fewer treatment resources available to treat individuals with substance use disorders relative to states without work requirements, despite having a higher burden of opioid and other drug overdose deaths. As Medicaid work requirements begin to take effect, states should take into account the availability of addiction treatment when making decisions about eligibility and enrollment.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: In states implementing Medicaid work requirements, there is a need for rigorous prospective evaluations to track health and employment outcomes of individuals with substance use disorders. In particular, evaluating whether individuals with substance use disorders are more likely to lose their Medicaid eligibility due to lack of employment or active treatment will be important.  

MedicalResearch.com: Is there anything else you would like to add?

Response: It is worth noting that there is substantial variability in the Medicaid work requirement proposals. Some states consider individuals with a diagnosed substance use disorder exempt from work requirements. Other states require active treatment to maintain Medicaid eligibility. How these differences will play out during implementation remains to be seen

Citation: Substance Use Disorder Treatment Availability Among States Considering Medicaid Work Requirement.

Christine, P.J. & Tipirneni, R. J GEN INTERN MED (2020). https://doi.org/10.1007/s11606-019-05623-1 


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Last Updated on January 15, 2020 by Marie Benz MD FAAD