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Effects of Medicaid IMD SUD waiver on access to addiction treatment

医疗补助 IMD SUD 豁免对获得成瘾治疗的影响

基本信息

批准号：
10726979
负责人：
Tamara Janelle Beetham
金额：
$ 4.63万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10726979
关键词：
Accounting Address Adoption Ambulatory Care Buprenorphine Caring Clinical Complex Directories Disease Drug abuse Epidemic Evaluation Exclusion Face Goals Health Health Services Heterogeneity Improve Access Incentives Individual Industry Inpatients Institution Insurance Carriers Interdisciplinary Health Team Knowledge Life Maintenance Maintenance Therapy Measures Medicaid Methodology Minority Modeling Opioid Outcome Outpatients Overdose Overdose reduction Patients Persons Pharmaceutical Preparations Philosophy Physicians Policies Policy Maker Positioning Attribute Probability Process Provider Psyche structure Public Health Quality of Care Quasi-experiment Research Personnel Residential Facilities Residential Treatment Resistance Stratification Structure Substance Use Disorder System United States Centers for Medicare and Medicaid Services United States Substance Abuse and Mental Health Services Administration Work addiction alcohol abuse therapy behavioral health beneficiary career cohort cost digital evidence base improved improved outcome insight medical specialties medically underserved population medication for opioid use disorder novel opioid use disorder overdose death overdose risk payment policy implication programs skills substance use treatment treatment program waiver

项目摘要

PROJECT SUMMARY Despite growing overdose fatalities primarily driven by opioids, only 10% of people with a substance use disorder (SUD) receive treatment. Yet evidence-based medication therapies that can reduce overdose risk exist, such as long-term buprenorphine maintenance therapy, but are vastly underutilized. As the most common insurer for people with opioid use disorder (OUD), the Medicaid program is uniquely positioned to improve access to evidence-based care and curb the tremendous toll of the overdose epidemic. However, prior work shows Medicaid beneficiaries face steep barriers accessing MOUD in outpatient settings due to low Medicaid provider participation and half of providers not accepting new Medicaid patients. Residential treatment programs are even less likely to participate in Medicaid than the outpatient setting due in part to the Institution for Mental Diseases (IMD) exclusion, a long-standing policy prohibiting federal matching of Medicaid payments for residential addiction treatment. Starting in 2015, states were able to apply for 1115 Substance Use Disorder IMD waiver demonstration projects, which would permit federal reimbursement for residential treatment. Waiver approval and renewal was contingent upon states proposing a plan to improve the accessibility and quality of their addiction treatment systems at large for Medicaid beneficiaries, including improving access to life-saving therapies such as buprenorphine. The long-term goal is to facilitate improved outcomes for individuals with SUD through transformation of the addiction treatment industry. The objective of the current application, which is the next step towards that goal, is to evaluate if IMD SUD 1115 waiver implementation is associated with changes in whether residential and outpatient treatment programs improve access to evidence-based behavioral health therapies for medically under-served populations. I use a quasi-experimental approach and consider outcomes in IMD waiver states before and after waiver implementation relative to states without waivers. The project’s PI and dissertation committee is an interdisciplinary team of health services researchers, health economists, and a physician with the methodological and substantive expertise to examine this understudied issue and explore its complex public health, clinical, and policy implications. The specific aims are to assess whether IMD waiver implementation is associated with changes in whether facilities accept Medicaid, offer any buprenorphine therapy (verses none), and offer buprenorphine maintenance therapy (verses no maintenance). The project is significant, as it focuses on how to structure reforms to address a key challenge in addiction treatment: incentivizing treatment programs to participate in Medicaid and offer evidence-based care. It is timely, as most waivers are coming up for review and findings can inform the Centers for Medicare and Medicaid Services’ renewal review process.

项目总结