The Opioid Epidemic and Medicaid’s Role in Treatment: A Look at Changes Over Time

The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid plays an important role in addressing the epidemic, covering 3 in 10 people with opioid addiction in 2015. However, the proposed changes to Medicaid as proposed in Better Care Reconciliation Act could set back states’ efforts to address the epidemic.

From 2005 to 2015, the number of people with heroin and prescription opioid addiction increased substantially. SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration Results from the 2015 National Survey on Drug Use and Health: Detailed Tables

Opioid-related inpatient stays and emergency department visits also increased dramatically during this time. SOURCE: Audrey J. Weiss, et al., Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009-2014 (Rockville, MD: Agency for Healthcare Research and Quality, December 2016), https://www.hcup-us.ahrq.gov/reports/statbriefs/sb219-Opioid-Hospital-Stays-ED-Visits-by-State.jsp

In 2005, about half of states had an opioid overdose death rate less than 5.0/100,000, and the states with the highest death rates were in the southwest. WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL Deaths per 100,000 1.0-5.0 5.1-10.0 10.1-15.0 SOURCE: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database

By 2010, the majority of states had death rates exceeding 5 By 2010, the majority of states had death rates exceeding 5.0/100,000, and the death rate in two states exceeded 15.0/100,000. WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL Deaths per 100,000 1.0-5.0 5.1-10.0 10.1-15.0 15.1+ SOURCE: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database

In 2015, nearly a quarter of states had death rates exceeding 15 In 2015, nearly a quarter of states had death rates exceeding 15.0/100,000, most of which were in Appalachia and New England. WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL Deaths per 100,000 1.0-5.0 5.1-10.0 10.1-15.0 15.1+ SOURCE: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database

Percent Increase in Death Rate Between 2005 and 2015, the increases in the opioid overdose death rate were particularly prominent in CT, DE, MS, NH, NY, OH, and WV. WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL Percent Increase in Death Rate <50% 50-149% 150-249% ≥250% SOURCE: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database

Medicaid covered 3 in 10 nonelderly adults with opioid addiction in 2015, nearly double the share covered in 2005. This increase was largely due to the ACA’s Medicaid expansion. SOURCE: Kaiser Family Foundation Analysis of 2015 National Survey on Drug Use and Health

Medicaid coverage of nonelderly adults receiving outpatient treatment for opioid addiction grew from 27% in 2005 to 39% in 2015. SOURCE: Kaiser Family Foundation Analysis of 2015 National Survey on Drug Use and Health

The share of nonelderly adults receiving inpatient treatment for opioid addiction who were covered by Medicaid doubled from 2005 to 2015. SOURCE: Kaiser Family Foundation Analysis of 2015 National Survey on Drug Use and Health

The Congressional Budget Office estimates dramatic reductions in federal Medicaid spending and Medicaid enrollment in the Better Care Reconciliation Act of 2017. Dollars in Billions (Reduction in Federal Medicaid Spending 2017-2026 = $772 billion) Updated 12/2014 (LS) SOURCE: CBO Estimate of H.R. 1628, Better Care Reconciliation Act of 2017, As a Substitute Posted on June 26, 2017.

The BCRA includes 3 big changes to Medicaid that could impact states’ ability to address the opioid epidemic: The enhanced federal financing for the Medicaid expansion population will be phased out. Medicaid will be converted to a per capita cap allotment, limiting available funds to states. Medicaid expansion plans will no longer be required to cover addiction treatment services, limiting enrollees’ access to care. Although the BCRA allots $2 billion in grants to provide addiction treatment, Medicaid spending on treatment is much higher. Medicaid also facilitates access to other medical and behavioral health preventative and treatment services not covered by these grants.