Estrada Miguel Antonio Garcia, Steuart Shelby R, Andrews Christina M, Grogan Colleen M, Hinds Olivia M, Lawler Emily C, Lozano-Rojas Felipe, Westlake Melissa A, Peterson Lauren, Wing Coady, Abraham Amanda J
Department of Public Administration and Policy, University of Georgia, United States.
Crown Family School of Social Work, Policy, and Practice, The University of Chicago, United States.
Drug Alcohol Depend Rep. 2025 Aug 22;16:100374. doi: 10.1016/j.dadr.2025.100374. eCollection 2025 Sep.
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.
酒精使用障碍(AUD)影响着十分之一的美国人。作为美国AUD治疗的最大支付方之一,医疗补助管理式医疗在促进获得AUD治疗服务和药物方面发挥着关键作用。然而,对于医疗补助管理式医疗组织(MCO)中的AUD保险覆盖范围如何影响治疗接受情况,人们知之甚少。我们研究了医疗补助MCO计划对AUD治疗的覆盖范围的全面性与AUD药物(MAUD)的接受情况之间的关系。我们使用了肯塔基州(2016 - 2019年)的医疗补助理赔数据;我们的最终分析样本包括202,230名新参保的医疗补助受益人。肯塔基州将医疗补助受益人准随机分配到五个具有不同AUD治疗覆盖范围的MCO计划之一。我们采用两阶段最小二乘法/工具变量(TSLS/IV)方法利用对MCO计划的随机分配来估计MCO计划全面性对MAUD接受情况的影响。AUD诊断和MAUD的接受情况相对不常见——在所有计划中,只有0.5%的医疗补助受益人被诊断为AUD并接受了MAUD。结果显示,相对于平均水平,每增加一种涵盖的AUD治疗方式,接受MAUD的概率就增加6.7%[平均水平:0.5%;每增加一项服务/MAUD的差异(百分点):0.033;p < 0.05]。将覆盖范围最窄的MCO计划扩大到与覆盖范围最广的计划相匹配,将使接受MAUD的概率提高47%。总体而言,研究结果表明,当保险计划涵盖更广泛的AUD治疗服务和药物时,患者更有可能接受MAUD。