The massive national effort to return the Medicaid enrollment process to its pre-pandemic rules starting in April 2023 may have disrupted the care of people receiving treatment for opioid addiction, a new University of Michigan study suggests. The researchers call this finding concerning, because the disruption may increase the risk of overdose or other negative impacts from opioid use disorder in states that were most aggressive in removing people from Medicaid coverage during the “unwinding” process in 2023.
The study has implications for the current debate over the future of Medicaid funding, which may result in further changes in eligibility in some or all states. Although opioid overdose deaths have declined somewhat, they are still as high as they were early in the pandemic, with around 80,000 Americans a year dying from this cause.
The new analysis, published in JAMA Network Open, looks at prescriptions for buprenorphine, a medicine that can help someone with opioid use disorder achieve and maintain recovery. It includes data from more than 569,000 adults across the country who had Medicaid coverage and received buprenorphine during the pre-unwinding period.
The researchers found that patients were less likely to continue to fill buprenorphine prescriptions and more likely to pay for buprenorphine with cash or private insurance if they lived in states with the biggest versus smallest Medicaid enrollment drops.
The future of Medicaid may change those eligibility criteria further if states receive less from the federal government or experience changes in their ability to fund the state’s share of the program from tax revenues.
Nearly 72 million Americans are currently enrolled in Medicaid after the end of the unwinding, and an additional 7.2 million children are enrolled in the Children’s Health Insurance Plan or CHIP, which also relies on Medicaid funding. Ten states have not expanded Medicaid under the Affordable Care Act, but those that have done so offer coverage to all individuals up to 138% of the federal poverty level, or about $21,000 for an individual and $36,000 for a family of three.
