A report by the Office of Inspector General reveals stark disparities in access to medications for opioid use disorder (MOUD). Age-based disparities are most pronounced, with individuals under 18 having limited access. Racial disparities are also evident, with Black individuals facing barriers. MOUD is considered the gold standard for opioid use disorder treatment. Geographic disparities in MOUD utilization are noted. Recommendations include CMS collaboration with states to eliminate barriers and enhance patient education efforts.
Access to Medications for Opioid Use Disorder Reveals Racial Health Disparities
A report from the Office of Inspector General has shed light on significant disparities in access to medication for opioid use disorder (MOUD), with age-based disparities being the most pronounced. In 2021, out of the 1.5 million Medicaid enrollees grappling with opioid use disorder, approximately one-third did not receive MOUD treatment. Alarming racial disparities also surfaced in this context.
Specifically, Black individuals, those below the age of 18, and those with disabilities or blindness faced substantial barriers to accessing MOUD compared to their counterparts.
MOUD, comprising medications like methadone, buprenorphine, and naltrexone, is widely recognized as the gold standard for treating opioid use disorder. With Medicaid covering approximately 40 percent of non-elderly adults with OUD, the report highlights the critical role played by this public payer in connecting patients to care.
In 2021, of the 1.5 million Medicaid enrollees eligible for MOUD, only 66 percent were able to access at least one of the medications within the MOUD framework. However, this access was far from uniform across different demographics, as revealed by the analysis of Medicaid claims data.
While 66 percent of the general population in need of MOUD received treatment, only 53 percent of Black or African American individuals did, in contrast to 71 percent of White individuals with OUD who received medication.
Disparities also extended to Medicaid enrollees with disabilities or blindness. While 67 percent of those without disabilities could access MOUD, only 56 percent of those with disabilities enjoyed the same privilege.
The most significant disparities emerged based on age, with a mere 11 percent of individuals under 18 with OUD receiving medication, in stark contrast to 70 percent of those aged 19 to 44, 61 percent of those aged 45 to 64, and 47 percent of those over 65.
Apart from patient demographics, geographic disparities in health care access were also identified. MOUD utilization was notably higher in northeastern states like Maine, Vermont, New Hampshire, Massachusetts, and Rhode Island, but considerably lower in others, including Wyoming, Nevada, Utah, Texas, Kansas, Arkansas, Mississippi, Illinois, New York, and Georgia.
These geographic disparities may be attributed to the fact that Medicaid is administered by state-led agencies. To address these disparities, the Office of Inspector General recommended that the Centers for Medicare & Medicaid Services (CMS) collaborate with states and federal partners to eliminate barriers to MOUD access. These efforts should prioritize equitable access and target populations with historically limited MOUD access.
The report also highlighted potential obstacles to improvement, such as a shortage of qualified providers to administer MOUD and the stigma associated with its use. To enhance patient education and navigation efforts, the CMS was advised to work closely with states, particularly state Medicaid agencies, to better understand how they can assist Medicaid and CHIP enrollees in accessing available resources.
While the CMS did not explicitly endorse or oppose these recommendations, the Office of Inspector General recognized their ongoing efforts while stressing the need for additional action in light of the concerning findings.
