Alcohol treatment in Medicaid managed care plans: Disparities in policies and outcomes

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Rates of alcohol-related morbidity and mortality are disproportionately high and increasing among racial/ethnic minorities and women and in rural areas. Almost 90,000 Americans die annually from alcohol use. Despite the health consequences, fewer than 10% of those with alcohol use disorder (AUD) receive evidence-based treatment, and racial/ethnic minorities and women are less likely to access treatment. Barriers to treatment include stigma, treatment setting appeal, and health insurance benefit design. Medicaid programs are among the most important payers for AUD treatment and rates of AUD in the Medicaid population are especially high. Medicaid provides health insurance for more than 77 million Americans, including a large and disproportionate share of racial/ethnic minorities, women, and rural Americans. Almost all state Medicaid programs contract with Medicaid managed care organizations (MMCOs) to deliver and manage health care services and nearly 70% of Medicaid enrollees are now in managed care. MMCOs must adhere to state requirements and policies, but have considerable discretion over polices that may influence access, treatment appeal, and cost. However, there is almost no information or transparency on MMCO polices related to alcohol treatment services. This study systematically examines AUD treatment policies in MMCOs, an under-explored level where important decisions are made that influence access and outcomes. We will conduct a national survey of MMCOs and link their responses to patient-level Medicaid data. The specific aims are: 1) Examine Medicaid MMCO alcohol treatment policies (e.g. coverage, utilization management, provider networks, innovations) across MMCOs that contract with the 50 states and District of Columbia; determine whether there are differences in MMCO alcohol treatment policies by state Medicaid policies. 2) Assess the relationship between MMCO policies and access to AUD treatment (e.g. initiation and engagement in treatment, follow-up after hospitalization) by race/ethnicity, gender, and rural/urban geography. 3) Assess the relationship between MMCO policies and alcohol treatment outcomes (i.e.. treatment retention, pharmacotherapy duration, hospitalization, ED visit) by race/ethnicity, gender and rural/urban geography. Our interdisciplinary team is uniquely qualified with experience conducting four previous commercial health plan behavioral health studies, and conducting rigorous disparities and Medicaid analyses. Findings will provide valuable information on MMCO policies and their associations with access, treatment appeal and cost for racial/ethnic minorities and other Americans. This information can be used by plan administrators as they develop and implement policies, state Medicaid directors as they contract with and regulate MMCOs, and federal policy makers making determinations about Medicaid waivers and other efforts to improve access to alcohol treatment in the US.