Improving racial equity in opioid use disorder treatment in Medicaid

Dates: 2023-2028

Background:
Access to medications for opioid use disorder (MOUD) is not equitable. Black and Hispanic individuals are substantially less likely to receive MOUD and other overdose prevention services. The overdose death rate has risen nearly twice as fast for Black individuals as for White individuals in recent years. As the largest payer for MOUD and a key source of coverage for racial/ethnic minority groups, Medicaid is well-positioned to address inequities in MOUD.  For example, Medicaid programs could institute requirements for provider networks; invest in building capacity for minority-serving Medicaid providers to deliver MOUD; center equity measures in provider performance measurement; and alter managed care contracts to incentivize plans to address inequities in MOUD. There is, however, little evidence on which of these levers is most effective.

Objectives:
This multistate project aims to:

1. Examine racial/ethnic inequities in geographic access to MOUD providers among Medicaid enrollees.
2. Examine the contribution of provider- and MCO-level factors to racial/ethnic disparities in MOUD and decompose racial/ethnic disparities in MOUD into within vs. between provider (or MCO) effects.
3. Estimate the association between state policy on delivery system reforms and MCO contract provisions, and equity in MOUD.

Research Topics & Methods:
The project involves detailed analysis of Medicaid administrative claims from each participating state, with statistical testing to examine trends across states.

Implications:
This project will identify the place, provider, plan and policy drivers of racial/ethnic inequities in MOUD in 11 state Medicaid programs that are amenable to change. Our long-standing relationships with Medicaid officials allow us to share findings directly with policymakers who can act on them.

Collaborators:
Researchers at the University of Pittsburgh lead this project, which includes university researchers and Medicaid officials in 11 states.

Funder:
The project is funded by the National Institute on Drug Abuse (NIDA)