VA Medicaid Program Reduces ED Admissions for Opioid Use Disorder

February 17, 2020 - After the implementation of Virginia’s Medicaid program, Addiction and Recovery Treatment Services (ARTS), emergency department (ED) visit declined by 21.1 percent among beneficiaries with opioid use disorder (OUD), according to a recent Health Affairs analysis.

Similarly, OUD related ED visits and inpatient admissions declined 3.7 percentage points and 1.3 percentage points, respectively, after ARTS was implemented. And an average of 11.3 percent of beneficiaries with OUD were admitted to the hospital compared to 8.7 percent during the post period, a 23 percent relative decrease.

“Our analysis extended previous work, finding reductions in ED use and inpatient admissions- two of the costliest types of medical encounters following implementation of a major expansion of SUD treatment services,” researchers explained in the analysis. 

More than 100 people die from an opioid overdose every day, the analysis highlighted. And Medicaid has a major role in treatment for OUD among beneficiaries in comparison to those who are uninsured or privately insured.

Currently, 26 states have been approved of Medicaid Section 1115 demonstration waivers for substance use disorder (SUD) treatment from CMS.

On April 1, 2017, Virginia implemented its ARTS program to increase access to opioid treatment services for more than one million Virginia Medicaid beneficiaries. The program’s overarching goal was to transform the delivery system and increase coverage and access to medication-assisted treatment (MAT).

The program also added various behavioral health services to coordinate with physical health services, added coverage for peer recovery support, and implemented prescribing guidelines from the Centers for Disease Control and Prevention for opioid selection, dosage, and duration, the analysis explained. 

And in January 2019, all adults under 138 percent of the federal poverty level were granted access to Medicaid eligibility in Virginia, expanding care to almost 60,000 uninsured Virginians with SUD.  

The program has proven beneficial, the Health Affairs study showed.

Using Virginia Medicaid claims data for January 2016 to June 2018, researchers compared beneficiaries with opioid use disorder before and after ARTS implementation to beneficiaries with no substance use disorder (SUD). They uncovered that 65 percent of beneficiaries with OUD received addiction and recovery treatment after ARTS was implemented compared to 45 percent before. 

The probability of ED visits among beneficiaries without  (SUD) also decreased by 0.9 percentage points, from 13.5 percent to 12.6 percent. And the chances of an inpatient hospitalization declined for beneficiaries with opioid use disorder as the supply of opioid treatment across all levels of care increased (55 percent versus 45 percent). 

The number of intensive outpatient programs billing Medicaid more than doubled from 49 to 136, while the number of opioid treatment programs billing Medicaid increased from six to 39. 

 “Medicaid programs are critical to increasing access to treatment and improving the quality of care… future work should link Medicaid claims data to data from other state agencies- including those related to social services, housing, vital statistics, justice involvement, and education- to more fully examine the spillovers of Medicaid policy responses to the opioid crisis,” researchers concluded. 

Last month, Medicaid expansion states saw a six percent decreased rate in total opioid overdose deaths compared to states that did not expand Medicaid eligibility, according to separate research from the University of California Davis School of Medicine. 

There was a total of 383,091 opioid overdose fatalities between 2001 and 2017. But this number may have been higher had fewer states expanded Medicaid, the researchers pointed out. 

Specifically, Medicaid expansion prevented between 1678 and 8132 deaths by opioid overdose between 2014 and 2017. Counties within states that expanded Medicaid also saw an 11 percent decreased rate of fatal heroin overdoses and a 10 percent decrease in overdose deaths involving synthetic opioids other than methadone. 

Opioid overdose deaths likely went down in expansion states because of increased coverage for substance use disorder treatment. Medicaid reimbursement for prescriptions for medication-assisted treatment (MAT) also increased significantly more in expansion states, the researchers reported.