Medicaid and SUD Treatment: Benefits, Barriers, and Solutions

Rates of substance use disorders (SUDs) continue to reach unfortunate milestones, yet only 13 percent of the people who need treatment actually receive it. On top of that, only 11 percent of people with opioid use disorder receive one of the three safe and effective medications that could help them quit and maintain recovery.[1]

A top reason for these discrepancies is a lack of adequate health insurance and financial constraints. Lack of coverage is a serious issue for anyone, but especially those with SUD. Without adequate coverage, people with SUD can’t access the life-saving treatment and support they need.

Additionally, research shows that people with untreated SUD/AUD use at least twice as many health care services (and therefore incur at least two times as much in costs) as those with treated conditions.[2] In other words, those with SUD have significantly more health care needs, yet don’t have the means to receive it. The result of this treatment gap is devastating, with overdose rates hitting historical highs.

Improving Health Outcomes for Those with SUD

Not only does SUD take a major toll on the health of the physical body, but it also negatively impacts the mind. Many individuals with SUD also struggle with mental disorders, and vice versa.[3]

People with co-occurring disorders experience worse psychiatric symptoms, higher rates of suicidal and violent behavior, and significant physical health problems. They also use intensive health services more frequently, with more emergency department visits and longer inpatient hospital admissions.[4]

Pregnant women with SUD are another group that tend to have more health complications and higher medical bills. Pregnant women with SUD incur higher hospitalization costs than those without SUD. For example, the average cost of hospitalization for a pregnant woman who uses opioids is 38% higher than for others.[5]

And there are probably more pregnant women with SUD than you think. In fact, the prevalence of SUD among pregnant women is only slightly lower than in the general population.[6] Not having adequate health coverage as a pregnant woman with SUD can lead to devastating consequences for the mother, baby, and those close to them.

Why Medicaid Is Key to Inclusive SUD Care 

Medicaid is the largest source of funding for services that treat drug and alcohol addictions and the single largest payer of maternity care in the U.S., financing about 42% of all births.[7

Part of the Affordable Care Act (ACA), which was signed into law by former President Obama in 2010, called for the expansion of Medicaid eligibility. Medicaid expansion allows states to provide coverage to people who earn up to 138% of the federal poverty level (FPL).

Unfortunately, 11 states have yet to adopt Medicaid expansion. This leaves millions of low-income Americans without coverage and, consequently, SUD care.

Moving Toward a Solution

How can state and federal policymakers make progress toward ensuring all people with SUD have access to a comprehensive system of care? Here are a few key moves to consider: 

Expand Medicaid coverage in all states 

In the states with expanded Medicaid, the program has proven to be an impactful tool for improving coverage and access to care for those with SUD. The rate of uninsured people with opioid-related hospitalizations dropped significantly in states with Medicaid expansion, from 13.4 percent in 2013 (the year before expansion took effect) to 2.9 percent in 2015.[8]

Additionally, one study found that Medicaid expansion increased admissions by about 50 percent to treatment facilities in which patients received medication assisted treatment (MAT)—the gold standard treatment for opioid use disorder.[9]

Consider a state-wide CCBHC model

A Certified Community Behavioral Health Clinic (CCBHC) model is designed to ensure that anyone who needs behavioral health care has access to it. CCBHCs are required to offer their services to anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, or age.

One report on the impact of CCBHC implementation states that the CCBHC model increases access to mental health and substance use care, largely due to increased availability of same-day appointments, expanded hours of operation, and resolute efforts to reach out to underserved groups.[10]

Employ evidence-based practices to support treatment and recovery

It’s essential that state Medicaid plans cover a full spectrum of evidence-based SUD services. Unfortunately, this is currently not the case. In fact, only 12 states’ Medicaid plans covered the full range of SUD services in 2018.[11]  

For instance, as of 2018, 38 states covered at least some peer support services for people with SUD.[12] This may sound like a substantial number, but the peer support services are limited to specific settings or beneficiaries, such as people transitioning out of institutional care. 

Another example is medication assisted therapy (MAT) for opioid use disorder. This treatment, which combines medication with behavior therapy, is strongly supported by research yet remains under-used. Widespread access to MAT would be a game changer for those with SUD.

Address Social Determinants of Health (SDOH)

Low-income individuals, including many Medicaid beneficiaries, face a higher risk of unmet social needs that may interfere with their SUD recovery. For instance, remaining in SUD recovery is very challenging if a person can’t meet basic needs like housing and food. 

It’s therefore necessary to expand and improve access to federal programs, such as affordable housing, food stamps, and child care programs, that address unmet social needs that create barriers to care.

Be Part of the Change with CHESS Health 

At CHESS Health, we collaborate with health plans, state and local governments, other public sector organizations, and individual clinical providers to get our life-saving apps—Connections and Conexiones—on to the smartphones of those struggling with SUD.  

Our apps provide ongoing support and relapse prevention to people struggling with SUD, when and where they need it. Through fully integrated digital platforms, our apps also help clinicians streamline the screening process, including SBIRT (screening, brief intervention, referral to treatment). 

If you’re interested in learning more about the groundbreaking technology we offer and how it can improve the rate and success of SUD treatment, get in touch with CHESS Health today