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Medicaid Makes Outpatient Opioid Addiction Treatment Affordable

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The opioid epidemic takes a staggering toll on the United States. In the past two decades, around 400,000 people have died from opioid-related overdoses. And for the first time, Americans are now more likely to die from opioid overdose than from a car crash.

Needless to say, access to opioid addiction treatment is more important than ever.

Isn’t Addiction Treatment Expensive?

We know that cost is generally the number one barrier that prevents access to treatment. Many inpatient treatment programs can cost tens of thousands of dollars for 30-day stays. While inpatient or residential treatment can be useful for some people, not everyone needs to live in a treatment center in order to achieve recovery.

Outpatient medication-assisted treatment (MAT), however, is far less expensive than inpatient treatment and it’s often covered by insurance.

MAT has been established by research and clinical science as the gold standard of care for opioid addiction. It works by using FDA-approved medications for opioid addiction – including buprenorphine (Suboxone) – in combination with counseling and behavioral therapies. Suboxone blocks the high associated with opioid use while relieving cravings and preventing withdrawal symptoms.

Medicaid Expansion and Addiction Treatment

Medicaid is a government insurance program designed to provide care for the elderly and disabled, as well as low-income individuals. It provides free or low-cost health insurance to individuals based on income and family size.

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The three main goals of the legislation were:

  • Making health insurance more affordable through tax credits
  • Expand Medicaid coverage to all adults with an income below 138% of the federal poverty level
  • Lower health costs through new technology and methods

After the expansion of Medicaid under the ACA, all adults with an income below 138 percent of the federal poverty level became eligible for coverage. Prior to that change, only disabled adults or adults with children were eligible for Medicaid, meaning MAT was unavailable to many low-income adults battling addiction.

The ACA drastically increased availability and access of addiction treatment, calling it an “essential health benefit.” Medicaid now represents one of the most common methods of paying for addiction treatment. In fact, the program pays for one fourth of all Suboxone prescriptions. In some states where government health insurance has expanded and addiction treatment numbers are higher, Medicaid pays for almost half of all Suboxone prescriptions.

The problem is that less than half of all addiction treatment programs have chosen to offer MAT, meaning only one third of the patients with opioid addiction actually receive this form of life-saving treatment.

Medicaid and Medication-Assisted Treatment (MAT)

According to the National Institute on Drug Abuse (NIDA), patients treated with medications like Suboxone are more likely to remain in treatment, compared to those receiving no medication. Additionally, the National Institute on Drug Abuse found that MAT decreases opioid abuse, opioid-related overdose deaths, criminal activity, and infectious disease transmission.

With Medicaid coverage, however, outpatient MAT is usually free to patients. There are some states where coverage still varies by state plan. Some state plans may not cover all costs, while others may cover everything with guidelines (such as how long Suboxone will be covered).

Several state Medicaid programs have made impressive headway in expanding access to MAT. For example:

  • Virginia saw a 25 percent decrease in emergency department visits related to opioid abuse. They also saw a 6 percent decrease in inpatient hospital admissions related to opioid addiction.
  • Rhode Island increased its MAT treatment retention rates for opioid addiction by 50 percent.
  • Vermont saw a 96 percent decrease in opioid use, a 90 percent reduction in illegal activity and police detentions/arrests, and a $6.7 million decrease in healthcare costs among a group of MAT program study participants.





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