Adolescents with SUDs in Medicaid Rarely Get Substance Abuse Care

Adolescents enrolled in Medicaid who had substance abuse-related experiences, including opioid use disorder, had high rates of medical visits but were unlikely to receive substance abuse care, indicating a need for increased Medicaid services, an Urban Institute report found.

Substance use is common among adolescents and can lead to high rates of morbidity and mortality. Medicaid provides health insurance coverage for over half of Americans under the age of 19, putting the public payer in a key place to help address and prevent substance use disorders.

Medicaid offers coverage for screening and intervention services related to substance use through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, but low reimbursement rates and other Medicaid policies may lead to low utilization of these services.

Researchers analyzed data gathered from the National Survey on Drug Use and Health from 2015 through 2019, which consisted of survey responses from and demographics of 31,680 adolescents between the ages of 12 and 19 years who received coverage from Medicaid or the Children’s Health Insurance Program (CHIP).

The researchers categorized the adolescents into the following five substance use groups: those with no substance use, those with opioid use disorder, those with risky opioid use but not opioid use disorder, those with a non-opioid and non-tobacco substance use disorder, and those who used non-opioid substances but did not have a use disorder.

Health problems were more common among adolescents who used substances. For example, adolescents with opioid use disorder were twice as likely to have fair or poor health and ten times as likely to have a sexually transmitted disease than those who did not use substances. Substance users in general were more likely to have had a major depressive episode as well.

While most of the adolescents enrolled in Medicaid had a healthcare appointment in the last year, adolescents who used substances were more likely to have a medical visit, particularly an emergency department visit or an inpatient stay.

More than 60 percent of adolescents with opioid use disorder and 47 percent of those with risky opioid use or other substance use disorders had at least one emergency department visit in the last year, compared to 32 percent of non-users.

Despite the high rates of healthcare services, adolescents who used substances did not commonly receive treatment for their substance use. Only one in five adolescents was involved with a substance use prevention program outside of school.

Although substance use treatment was highest among adolescents with opioid use disorder, less than one in five received treatment, while 6.9 percent had received buprenorphine treatment and 8.6 percent had received alcohol-related treatment, the report stated. Just over 4 percent of adolescents with opioid use disorder sought treatment but never accessed it.

Only half of all adolescents who had a medical visit in the last year received substance use screenings during their appointments, the researchers found.

The study results indicate a need for better resources to address substance use in adolescents. Medicaid has the potential to help by enacting policy changes.

“The EPSDT Medicaid benefit could be expanded to explicitly include outreach and engagement with youth before a diagnosis, confidential screening and assessment, early intervention services, unlimited case management for comprehensive care coordination, and transportation to care,” researchers wrote.

However, providers may struggle with this increased care delivery without adequate reimbursement from Medicaid, thus the researchers recommended that policymakers should look to expand benefits through waivers. These waivers could cover therapeutic services such as mentoring, art therapy, and alternative recreational therapies.

The public payer should also take action to improve access to recovery services, including peer recovery coaching and recovery housing, the researchers urged.

Medicaid must also start reimbursing providers for harm reduction services for adolescents, the report concluded.