Medicare and Medicaid Patients With Opioid Addiction Less Likely to Receive Care, Study Shows

Patients addicted to opioids are less likely to receive behavioral health care if they rely solely on public insurance, compared to those receiving care through multiple funding sources, according to a Rutgers University study published in Addiction Science & Clinical Practice.

“It’s the exact opposite of how we should be helping people,” Jamey Lister, Ph.D., associate professor at the Rutgers School of Social Work and the study’s principal investigator, said in a news release. “We should aspire to provide health care services that are driven by patient need, not by financing. But as we found, if you're only using public insurance, you’re likely falling through the cracks.”

Researchers reviewed electronic health records for 705 patients diagnosed with opioid use disorder who received treatment at a community health center in a large urban area of New Jersey between 2015 and 2021.

The study found that patients with only Medicare or Medicaid and a co-occurring mental health condition accessed behavioral health care an average of 32 times. Similarly, patients with only Medicare or Medicaid and a co-occurring mental health condition accessed behavioral health care an average of 31 times. In contrast, those with a combination of public insurance and other funding sources accessed care 71 times. These additional sources included charity care, other public programs or court- or probation-mandated treatment.

Opioid use disorder is one of the most common substance use disorders. In 2021, opioid toxicity accounted for 1 in 22 deaths in the United States, the study noted. Mental health and substance use disorders are comorbid in about 10% of U.S. adults.

Approximately 72% of patients in the study had both an opioid use disorder and another substance use disorder, including cannabis, cocaine or alcohol. Most participants were male (70%), 40% were African American and approximately 40% had a co-occurring mental health disorder such as depression, anxiety or bipolar disorder.

The study grouped patients by insurance type—Medicare or Medicaid, charity care, other public funding or private insurance—and measured the frequency of care, including psychotherapy, psychiatric and group therapy sessions.

“What's most striking is how insurance type fundamentally shapes patient treatment,” Lister said. “It is essential that we not only improve our understanding of the complex needs of individuals with co-occurring disorders, including individuals with opioid use disorder, but that we also do so with a lens toward the disparities in care access.”

The findings come as proposed federal budget cuts could reduce Medicaid spending by $863 billion between fiscal years 2025 and 2034, according to The Commonwealth Fund. These cuts contrast with findings from a 2021 American Medical Association study that found expanding access to opioid addiction treatment could save $25,000 to $105,000 in lifetime costs per person. In 2021, opioid overdose, misuse and dependence cost the U.S. health system an estimated $35 billion.

New Jersey expanded its Medicaid program under the Affordable Care Act on Jan. 1, 2024, aiming to improve access to care for low-income residents, including those with substance use disorders.