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Medicaid Must Play a Central Role in Combating Substance Use Disorder

By Shawn Gremminger,


As the largest single source of health insurance and coverage for behavioral health services in the country, Medicaid plays a pivotal role in addressing substance use disorder (SUD). Medicaid covers nearly 4 in 10 non-elderly adults in the country with opioid addiction. But this coverage could go further: at least 17 percent of opioid addicts are uninsured, a rate nearly 50 percent higher than the general population.

As this new fact sheet explains, state Medicaid programs are effective in providing access to MAT medications. Of the three MAT medications—Buprenorphine, Methadone, and Naltrexone—every state program covers Buprenorphine, and a majority of state Medicaid programs cover all three.  Medicaid programs cover a wide variety of behavioral health treatment services, although there is important and problematic variation among states: more than half of states cover detoxification and other inpatient services, and half of states cover care coordination. Access to all of these lifesaving services is substantially curtailed for those who remain uninsured.

The percentage of adults with SUDs is about the same among Medicaid-covered and uninsured adults, but Medicaid-covered adults are more than twice as likely to receive outpatient SUD rehabilitation as uninsured adults. Medicaid beneficiaries are three times as likely to receive care at an outpatient mental health center, and more than eight times as likely to receive SUD treatment in an inpatient setting as uninsured adults.

Recommendations for Congress and the administration

Read the entire fact sheet for details, but here are Families USA’s primary recommendations:

  • Policymakers must recognize that tweaks to existing health care systems, while commendable, are insufficient to fully address the most significant public health crisis of this generation. To truly make an impact on the opioid crisis, Congress must allocate significant new funding.
  • Medicaid coverage is the most important tool available to policymakers to combat the opioid crisis. Congress and the administration should prioritize and support Medicaid expansion in all 50 states and maximize the use of Medicaid as the vehicle for getting new SUD resources to states.
  • Congress and the administration should reject barriers to Medicaid coverage that would significantly limit access for those suffering from SUD. These barriers include Medicaid work requirements, mandatory drug testing, and time limits for Medicaid coverage.