High Levels of Substance Use Disorder Among Critically Ill Virginia Medicaid Beneficiaries

Objectives: Substance use disorder (SUD) affects critically ill patients before, during, and after their intensive care unit (ICU) stay. Medicaid is the primary payor for patients with SUD and an increasing number of ICU stays; however, little is known about the prevalence of SUD among Medicaid-covered ICU beneficiaries. Methods: Using Medicaid claims from Virginia in 2023–2024, we examined the prevalence of SUD, demographic characteristics, specific types of SUD, and SUD-related characteristics among Medicaid beneficiaries ages 18–64 with an ICU and compared these ICU beneficiaries to 2 groups: beneficiaries with a non-ICU hospitalization and beneficiaries with no acute hospitalizations. Results: Nearly half of Medicaid ICU beneficiaries have a SUD 49.2% (95% CI: 48.3-50.1), over 8 times higher than general Medicaid and >20% higher than beneficiaries with non-ICU hospitalizations. Almost one in 5 ICU beneficiaries 19.2% (95% CI: 18.3%–19.8%) had a stay for overdose or withdrawal, twice the rate of Medicaid beneficiaries with a non-ICU hospitalization. SUD was more prevalent among beneficiaries with an ICU hospitalization across most beneficiary demographic characteristics and types of SUD with alcohol and “other” (polysubstance/unknown) SUD relatively greater among beneficiaries with an ICU hospitalization compared with beneficiaries with non-ICU hospitalizations and all beneficiaries. Conclusions: SUD is highly prevalent among Medicaid beneficiaries with an ICU hospitalization. Further studies are required to understand the needs of critically ill patients with SUD. Efforts by Medicaid and managed care organizations to promote SUD treatment during hospitalization may improve the long-term recovery of critically ill patients.