Medicaid Enrollees With Opioid Use Disorder Were More Likely To Receive Medication Treatment Than Commercial Enrollees

Medications for opioid use disorder (MOUD) are underused in the treatment of people with OUD; insurance-related barriers are a possible driving factor. We used Wisconsin's all-payer claims database for 2021–22 to examine differences in MOUD treatment probabilities among nonelderly adults with Medicaid insurance compared with those with commercial insurance. We found that Medicaid enrollees with OUD were 9.8 percentage points more likely to receive MOUD than commercial enrollees with OUD. Some of this gap can be explained by lower treatment rates among older enrollees and the older age distribution of commercial enrollees, as well as the fact that Medicaid enrollees are more likely to see primary care providers with more OUD experience. However, after we controlled for patient age, sex, comorbidities, and provider fixed effects, a substantial unexplained difference of 7.1 percentage points remained, potentially indicating a role for direct plan-level effects or unobserved patient characteristics. Policies aimed at improving commercial insurance coverage, training more providers, and targeting older populations may be needed to increase overall MOUD treatment rates.