Opioid Treatment Programs’ Medicaid Patient Retention Rates

Importance Retention on methadone and buprenorphine has been shown to be associated with reduced overdose and death. Opioid treatment programs (OTPs) are the only health care facilities in the US licensed to dispense methadone for opioid use disorder (OUD), and they increasingly prescribe buprenorphine. By measuring and comparing their patient retention rates, after adjusting for patient characteristics, OTPs can determine if their retention rate is low relative to other OTPs, which may motivate efforts to improve patient engagement and outcomes. Objective To develop a standardized case mix–adjusted measure for evaluating Medicaid patient retention in OTPs. Design, Setting, and Participants This cohort study used Medicaid outpatient claims and demographic data from 2018 to 2023. All OTPs in the US with at least 11 non–dually eligible Medicaid beneficiaries aged 18 years or older with an OUD diagnosis were included. Analyses were completed between January and October 2025. Exposure OUD treatment at OTPs. Main Outcomes and Measures The percentage of an OTP’s Medicaid patients who remained in treatment at the OTP for greater than 30 days, greater than 90 days, and greater than 180 days. Retention rates were calculated for 5 measurement years (2019 through 2023; eg, July 1, 2018, to June 30, 2019) and underwent case mix adjustment using Medicaid data and patient characteristics. Results This study included 261 025 Medicaid beneficiaries (140 718 males 53.9%; mean SD age, 39 9.92 years) with 432 918 episodes of treatment at 1138 OTPs in measurement year 2023. The median (IQR) 30-day, 90-day, and 180-day retention rates were 61.2% (40.9%-73.5%), 41.5% (22.2%-54.8%), and 27.5% (11.4%-40.5%), respectively, in measurement year 2023. Conclusions and Relevance This cohort study found low retention rates and variable treatment duration across OTPs. This result indicates opportunities for quality improvement.