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Buprenorphine Treatment Access Equitable in Areas Where Medicaid is Prevalent
In areas where Medicaid coverage is more common, providers of buprenorphine treatment are much less likely to discriminate between prospective patients with Medicaid and those with private insurance, according to a study published in Health Services Research.
“But the most striking finding is — for both callers that had private insurance and callers that had Medicaid — just how infrequently they’re able to actually leverage those insurance benefits when it comes to getting an appointment for opioid use disorder,” said study lead author Michael Richards, MD, PhD, MPH, an associate professor at Baylor University, Waco, Texas. “That really speaks to the many serious and substantive access hurdles these individuals have to clear.”
Dr Richards and coauthors conducted the study using county-level information on Medicaid enrollment combined with field experiment data from 10 states from a previous study. A “secret shopper” method featuring simulated patient callers determined how likely providers of buprenorphine treatment were to provide an appointment to women identifying themselves as having Medicaid coverage or private insurance coverage. In all, 3420 calls were made requesting appointments with buprenorphine providers.
Overall, less than half the callers were able to secure an insurance-covered appointment, according to the study: 45% of women with private insurance were granted an appointment compared with 38% of women with Medicaid insurance. In communities where Medicaid was a common insurance source, there was effectively no difference in the likelihood of being granted an insurance-covered appointment, the study found. In communities with lower Medicaid prevalence, callers with Medicaid were 11% less likely to obtain an appointment. As the share of the Medicaid coverage in the local population increased, the difference in access to care between callers with Medicaid and those with private insurance decreased, the study showed, until the difference was insignificant.
While the explanation is likely multifactored, researchers suspect providers in areas with a higher rate of Medicaid coverage may be more familiar with business processes needed to obtain payment from Medicaid for buprenorphine treatment. Efforts to improve access to treatment may be best targeted to areas where Medicaid prevalence is lower, they advised.
“Making it through the structural barriers to just getting into treatment for opioid use disorder is extraordinarily hard, even if you’re the most motivated person on the planet,” said study principal investigator Stephen Patrick, MD, MPH, of the department of health policy at Vanderbilt University Medical Center, Nashville, Tennessee. “We know these medications reduce risk of death, and yet it’s impossible for some folks to get into treatment.”
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