State Medicaid Agencies’ Multi-Faceted Response to the Opioid Epidemic
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Date
2021-09-29
Department
Program
Citation of Original Publication
Cole, Evan S., et al. State Medicaid Agencies’ Multi-Faceted Response to the Opioid Epidemic. Academy Health. Sept. 29, 2021. https://academyhealth.org/sites/default/files/publication/%5Bfield_date%3Acustom%3AY%5D-%5Bfield_date%3Acustom%3Am%5D/medicaidagenciesopioidresponse_sept2021.pdf."
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Abstract
Context: Medicaid is the primary payer for substance use disorder
(SUD) treatment in the United States. While some policy changes
have been well documented, the operational decisions that guide
the implementation of these policies have received insufficient
attention. The objective of this analysis is to describe the roles that
Medicaid programs have taken to address the opioid epidemic and
their policy and operational decisions.
Methods: We conducted 27 key informant interviews with state
agency representatives in 9 states, all of which have been substantially impacted by the opioid epidemic. We focused our interviews
on 3 distinct state roles: Regulator, Monitor, and Enforcer; Payer and
Contractor; and Collaborator, Evaluator, and Educator. Within those
roles, we aimed to synthesize the degree of variation of the policies
implemented across these states from 2014-2019, given the breadth of
policy levers available to them. Interviews were recorded and transcribed, responses were summarized categorically where possible, and
the transcripts were reviewed to identify areas of variation.
Findings: We observed substantial convergence in the policies and
actions taken by states. All 9 states relaxed or eliminated utilization
management policies, such as prior authorization of medications
for opioid use disorder, that may be a barrier to access. Most states
expanded SUD treatment coverage to align with the American
Society of Addiction Medicine continuum of care. As collaborators, Medicaid programs participated in interagency efforts such as
opioid task forces, including various levels of data-sharing between
agencies. Interviewees discussed ongoing evaluative activities; however, OUD treatment quality measurement remains an area in need
of development to support state policymakers.