Racial Health Disparities Emerge in Access to OUD Medications

A third of the 1.5 million Medicaid enrollees with opioid use disorder in 2021 did not receive medication to treat opioid use disorder (MOUD), with searing racial health disparities also present, according to an Office of Inspector General report.

Specifically, Black people, individuals younger than 18, and those with a disability or blindness were less likely to receive MOUD than their counterparts.

MOUD is considered the gold standard in opioid use disorder treatment. Medications comprising MOUD include methadone, buprenorphine, and naltrexone. Currently, Medicaid covers around 40 percent of non-elderly adults with opioid use disorder (OUD), which OIG said emphasizes the big role the public payer plays in connecting patients to care.

In 2021, the number of Medicaid enrollees who qualified for MOUD totaled 1.5 million, and around two-thirds (66 percent) of them were able to access at least one of the medications included in MOUD.

However, MOUD access was not equal across all demographics, the assessment of Medicaid claims data showed. While 66 percent of the general population needing MOUD got treatment, only 53 percent of Black or African American people did. This compares to 71 percent of White folks with OUD who received medication.

Disparities also affected Medicaid enrollees with blindness or disabilities. While 67 percent of people without disabilities could access MOUD, only 56 percent of those with disabilities could say the same.

The biggest health disparities were based on age, OIG found, with only around one in ten (11 percent) individuals under age 18 with OUD getting medication for it. This compares to 70 percent of those ages 19 to 44, 61 percent of those ages 45 to 64, and 47 percent of those over age 65.

In addition to patient demographics, OID detected geographic health disparities. While MOUD utilization was higher in northeastern states like Maine, Vermont, New Hampshire, Massachusetts, and Rhode Island, it was less common in others. Wyoming, Nevada, Utah, Texas, Kansas, Arkansas, Mississippi, Illinois, New York, and Georgia all had MOUD utilization rates lower than 50 percent.

These geographic health disparities may be unsurprising, considering the fact that Medicaid is run by state-led agencies. To mitigate the geographic health disparities, OID recommended the CMS work with states and federal partners to reduce barriers to MOUD. These efforts should be concentrated equitably and address populations that have demonstrated poorer access to MOUD.

Potential barriers to amelioration are the shortage of providers eligible for administering MOUD and the stigma surrounding its use, OIG suggested.

In addition, OIG advised CMS to work with states on patient education and navigation efforts. Particularly, CMS may work with state Medicaid agencies to understand how they can help Medicaid and CHIP enrollees access the resources available to them.

“CMS neither concurred nor nonconcurred with our recommendations,” OIG reported.

“The agency instead stated that it already works with States to increase access to MOUD and ensure that enrollees are educated regarding access,” OIG concluded. “OIG recognizes CMS's efforts; however, opportunities exist for additional action given our concerning findings.”