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

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

Figure 2

• 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.

Figure 3

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 AdministrationResults from the 2015 National Survey on Drug Use and Health: Detailed Tables

From 2005 to 2015, the number of people with heroin and prescription opioid addiction increased substantially.

227k

1.5M

359k

1.9M

591k

2M

Heroin Prescription Opioid

2005 2010 2015

Figure 4

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

Opioid-related inpatient stays and emergency department visits also increased dramatically during this time.

136.8

89.1

197.1

117.5

224.6

177.7

Inpatient Stays(per 100,000)

Emergency Department Visits(per 100,000)

2005 2010 2014

Figure 5

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 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

NVNE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KYKS

IA

INIL

ID

HI

GA

FL

DC

DE

CT

COCA

ARAZ

AK

AL

5.1-10.0

1.0-5.0

10.1-15.0

Deaths per 100,000

Figure 6

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

NVNE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KYKS

IA

INIL

ID

HI

GA

FL

DC

DE

CT

COCA

ARAZ

AK

AL

15.1+


5.1-10.0

1.0-5.0

10.1-15.0

Deaths per 100,000

Figure 7

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

NVNE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KYKS

IA

INIL

ID

HI

GA

FL

DC

DE

CT

COCA

ARAZ

AK

AL


15.1+

5.1-10.0

1.0-5.0

10.1-15.0

Deaths per 100,000

Figure 8

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

NVNE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KYKS

IA

INIL

ID

HI

GA

FL

DC

DE

CT

COCA

ARAZ

AK

AL50-149%

<50%

150-249%

≥250%

Percent Increase in Death Rate


Figure 9

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

17%23%

30%

42%37%

40%

8% 8%

10%

33% 32%20%

2005(1.4 million)

2010(1.9 million)

2015(2.3 million)

Uninsured

Other

Private

Medicaid

Figure 10

Medicaid coverage of nonelderly adults receiving outpatient treatment for opioid addiction grew from 27% in 2005 to 39% in 2015.

27% 31%39%

34% 28%

36%6% 12%

10%34% 30%

15%

2005(191,000)

2010(380,000)

2015(581,000)

Uninsured

Other

Private

Medicaid


Figure 11

The share of nonelderly adults receiving inpatient treatment for opioid addiction who were covered by Medicaid doubled from 2005 to 2015.

26% 31%

52%

23%21%

20%

4%

18%

14%48%

30%

14%

2005(146,000)

2010(274,000)

2015(299,000)

Uninsured

Other

Private

Medicaid


Figure 12

• 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 $44.7 billion in grants over 9 years 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.