Medicaid expansion boosts access to opioid use disorder treatment

Medicaid plays a key role for giving people with opioid-use disorder access to treatment, according to a Rutgers Health study.

Progress in life-saving treatment for opioid-use disorder with the medication has stalled in the past several years, according to a Rutgers Health study. However, researchers added that while some states were able to achieve substantial improvement, others lost ground. 

Specifically, states that have expanded access to Medicaid insurance coverage since 2018 saw increases in prescriptions for opioid-use disorder treatment, according to the study, while states that haven't expanded Medicaid experienced declining treatment rates after 2022. 

Researchers found that state Medicaid policies were key drivers of population-level treatment rates.

The study, published in Health Affairs, examined trends in national retail pharmacy claims by Medicaid, Medicare and private insurance across states between 2018 and 2024, a period of rising fatal overdose rates and national policy changes aimed at increasing treatment. Researchers compared the claims with state populations and overdose rates to assess the impact of Medicaid eligibility on treatment uptake.

We were impressed by the success stories in some states, such as those with recent eligibility expansions. Several of these states, like Virginia, Utah and Missouri, doubled or tripled Medicaid-paid prescribing, driving strong population-level improvement. These successes point to opportunities for improvement even when the overall national rate of progress is disappointing. Nevertheless, wide disparities between states remained, as shown in maps and state comparison tables in the paper and its appendix." 

Stephen Crystal, Director of the Rutgers Center for Health Services Research at the Institute for Health, Health Care Policy and Aging Research

Despite the availability of effective treatments for opioid-use disorder, more than 80,000 died in 2024from opioid-use overdoses. In addition to the disease of addiction, there are a number of policy and financial barriers preventing people from accessing medication, the researchers said. The federal government declared an opioid public health emergency in 2017 and again in 2025. 

Because people with opioid-use disorder tend to be low-income single adults, Medicaid is the most important payer for buprenorphine, a highly effective medication used to treat opioid-use disorder. However, Medicaid policies covering opioid-use disorder treatment vary state to state, resulting in vastly different uptake of treatments that can dramatically lower the risk of overdose and support recovery. New Jersey is among the states that have implemented important initiatives that have aided access to Medicaid-paid treatment, including Medicaid expansion, elimination of buprenorphine prior authorization, and increased reimbursement for treatment, with improvements in Medicaid and all-payer buprenorphine prescribing during the study period.

The national analysis led by Crystal, who is a Distinguished Research Professor at the Rutgers School of Social Work, showed diverse state-level trends that often pointed to the importance of Medicaid. 

States that recently expanded the eligibility criteria to qualify for Medicaid insurance experienced a 27.3% increase in buprenorphine prescribing rates. But in states that didn't expand Medicaid, overall prescribing lagged, with declines after 2022. 

Researchers said expanding Medicaid eligibility and minimizing disenrollment from Medicaid during eligibility redeterminations are critical steps in increasing access to opioid-use disorder treatment across the country.

"Translating evidence into consistent practice has been uneven across the country for multiple reasons, including the stigma surrounding people with addiction," said Crystal. "But progress is possible when states take action to help residents access and afford effective medication. Maintaining the progress that has been made in opioid-use disorder treatment through state Medicaid policies will be challenging under the financial pressures created by recent federal legislation, but it is vital in maintaining progress on preventing overdoses and supporting recovery."

Coauthors of the study include Fangzhou Xie, Hillary Samples, Elizabeth Stone and Jennifer Miles of Rutgers; Allen Campbell of the IQVIA Institute, Peter Treitler of Boston University; and Sumedha Gupta and Kosali I. Simon of Indiana University.

Crystal will discuss the research during the Health Affairs Health Policy Briefing focused on the opioid crisis on Sept. 3 and in an upcoming Health Affairs Health Podyssey podcast episode.