Aug. 10, 2021
Report: Virginia has significantly expanded access to addiction treatment services through Medicaid
VCU researchers report a 79% increase in Virginia Medicaid members receiving services between 2018 and 2019 — a result of both Medicaid expansion and an increase in treatment services offered.
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The Virginia Department of Medical Assistance Services last week released a report, led by a team of researchers at Virginia Commonwealth University, highlighting a significant increase in access to addiction and recovery treatment services as a result of Medicaid expansion.
More than 46,500 Medicaid members received care through the Addiction and Recovery Treatment Services benefit in 2019, the first year eligibility for health coverage expanded to more low-income adults, including childless adults who had been excluded under previous policies. Participation in ARTS increased 79% between 2018 and 2019.
Virginia launched the ARTS benefit in April 2017 to increase access to care for Medicaid members with substance use disorders and improve the quality of services available. Researchers in the Department of Health Behavior and Policy at the VCU School of Medicine have been conducting the independent, multiyear evaluation of the ARTS benefit.
“The findings show Virginia has made substantial and rapid progress over the past five years in expanding access to addiction treatment services through the Medicaid program — first by expanding treatment services through the ARTS program in 2017 and then by greatly expanding eligibility for these services through Medicaid expansion in 2019,” said Peter Cunningham, Ph.D., a professor in the Department of Health Behavior and Policy who is leading the evaluation with associate professor Andrew Barnes, Ph.D. “This has put the state in a much stronger position to address the surge in substance use disorders that we are seeing in Virginia and across the nation due to the COVID-19 pandemic.”
Researchers found that growth in the Addiction and Recovery Treatment Services benefit was driven not only by newly eligible adults but also through increased participation by Medicaid members who were already eligible for health coverage before the expansion. Treatment rates for addiction among the latter group grew from 19.9% in 2016, before the ARTS program began, to 47.4% in 2019. Treatment rates specifically for opioid use disorder among this group increased from 32.1% in 2016 to 65.9% in 2019.
“These findings demonstrate our ability to respond to the pressing need for addiction and recovery treatment at a time when the Medicaid program was experiencing historic growth,” said Ellen Montz, Ph.D., chief deputy and chief health economist with the Department of Medical Assistance Services. “Even so, we know there is more work to do to ensure that everyone seeking recovery has access to high-quality, evidence-based treatment. This research provides the data we need to achieve that goal.”
Nearly 4,900 outpatient practitioners provided care through the ARTS benefit in 2019, a 31% increase from 2018 and quadruple the number billing Medicaid for addiction services in 2016. The report found that Virginia providers have significantly increased the use of medication to treat opioid use disorder, bringing the commonwealth more in line with practices in peer states. However, researchers also noted a shortage of providers with federal authorization to prescribe buprenorphine, a medication for treating opioid use disorder.
In evaluating the quality of care available to Virginia Medicaid members, researchers found that, in 2019, 87% of Medicaid members with opioid use disorder received treatment within 30 days of discharge from a residential treatment facility and 53.5% received treatment within 30 days of an emergency department visit related to opioid use disorder.
Researchers also documented a 26% decrease in emergency department visits related to opioid use disorder between 2016 and 2018. In contrast, all other emergency department visits increased by 5% during that period.
In 2019, emergency department visits increased among Medicaid members for substance use disorders overall and opioid use disorder specifically. The report noted that there were 1,626 fatal drug overdoses in Virginia that year, a 9.4% increase compared to 2018, reflecting a national surge in overdose deaths.
Researchers examined continued racial disparities in treatment rates, with 56% of white Medicaid members and 40% of Black members receiving substance use disorder services. The report documented data indicating that Black Medicaid members are less likely to receive follow-up services and to continue treatment. Researchers noted that Black members reported having a less favorable experience with treatment compared to white members. Black members also reported that they felt less able to make their own choices about treatment options.
“This report documents tremendous accomplishments since the launch of the ARTS benefit,” said Tammy Whitlock, deputy of complex care and services at the Department of Medical Assistance Services, “and it also offers a rigorous analysis of necessary next steps to build trust and improve communication with our members in our continued effort to touch lives and reduce the unimaginable suffering in our families and communities.”
In addition to Cunningham and Barnes, authors of the report from the VCU School of Medicine’s Department of Health Behavior and Policy include Megan Mueller, Erin Britton, Huyen Pham, Lauren Guerra, Heather Saunders, Xue Zhao and Vimbainashe Dihwa.
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