Headline
Virginia’s comprehensive Medicaid reform for substance use treatment services led to an increase in outpatient and community-based treatment and a decrease in emergency department (ED) and inpatient use among beneficiaries with opioid use disorder (OUD).
Context
In 2017, Virginia implemented a comprehensive program, Addiction and Recovery Treatment Services (ARTS), to increase access to its full continuum of care for evidence-based addiction treatment services for Virginia’s Medicaid beneficiaries. Components of the program include a federal waiver to allow federal Medicaid reimbursements for short-term residential and inpatient addiction treatment, designing the delivery system around the American Society of Addiction Medicine’s (ASAM) criteria, transitioning to “carved in” behavioral health services under managed care, adding peer recovery services, implementing federal prescribing guidelines, and enhancing reimbursement rates for opioid treatment programs and office-based opioid treatment providers. The study looked at how this program increased access to outpatient and community-based addiction treatment impacted ED and inpatient utilization for Medicaid beneficiaries with OUD.
Findings
Using before-and-after claims data, the study found reductions in ED use and inpatient admissions. The reduction was most significant for beneficiaries with OUD ED use, which declined by over 9% between the five-quarter period prior to ARTS implementation and the five-quarter period after.
Takeaways
Because the ARTS program was multi-faceted, it is difficult to isolate the exact cause of these hospital use reductions. However, the study suggests that comprehensive reforms to a state’s Medicaid SUD program can contribute to reductions in ED visits and inpatient admissions, which are among the costliest types of medical encounters.