Relationship between Medicaid coverage design and receipt of medication for alcohol use disorder (MAUD): Probability of receipt increases based on comprehensiveness of plan

Abstract

Alcohol use disorder (AUD) affects one in ten Americans. As one of the largest payers of AUD treatment in the United States, Medicaid managed care plays a key role in facilitating access to AUD treatment services and medications. However, little is known about how AUD coverage in Medicaid managed care organizations (MCOs) affects treatment receipt. We examined the relationship between the comprehensiveness of Medicaid MCO plan coverage of AUD treatment and receipt of medications for AUD (MAUD). We used Medicaid claims data from Kentucky (2016–2019); our final analytic sample consisted of 202,230 newly enrolled Medicaid beneficiaries. Kentucky quasi-randomly assigns Medicaid beneficiaries to one of five MCO plans with different AUD treatment coverage. We leveraged the random assignment to MCO plans using a Two-Stage Least Squares/Instrumental Variable (TSLS/IV) approach to estimate the effects of MCO plan comprehensiveness on receipt of MAUD. Diagnosis with AUD and receipt of MAUD was relatively uncommon— only 0.5 % of Medicaid beneficiaries were diagnosed with AUD and received MAUD across all plans. Results showed that for each additional AUD treatment modality covered, the probability of receiving MAUD increased by 6.7 % relative to the mean [mean: 0.5 %; difference per additional service/MAUD (in percentage points): 0.033; p < 0.05]. Expanding coverage in the least comprehensive MCO plan to match the most comprehensive plan would increase the probability of receiving MAUD by 47 %. Overall, study findings indicate that when insurance plans cover a broader array of AUD treatment services and medications, patients are more likely to receive MAUD.