Medicaid expansion linked to reduced opioid-related hospitalizations
Medicaid expansion may have led to reductions in opioid-related hospitalizations between 2005 and 2017, according to a study published in JAMA Internal Medicine.
“Our findings suggest that expanding Medicaid may be a useful strategy for reducing opioid-related hospitalizations,” Hefei Wen, PhD, faculty member of the Harvard Medical School Department of Population Medicine at the Harvard Pilgrim Health Care Institute, and colleagues wrote. “This possible benefit may be due to better management of opioid use disorder in outpatient settings among newly insured individuals.”
Wen and colleagues compared differences in opioid-related hospitalizations and ED visits in nonfederal, nonrehabilitation hospitals in U.S. states that implemented Medicaid expansions between 2005 and 2017 and changes in these events in states that did not implement Medicaid expansion. Their analysis included hospital and ED discharge data from 45 states in the Healthcare Cost and Utilization Project FastStats, which include information on opioid use disorder and overdoses with all types of opioids.
The data were stratified by states that implemented Medicaid expansion that occurred before 2014 and during or after 2014 because the post-2014 expansions were more comprehensive under the Affordable Care Act.
The researchers evaluated 1,524 observations of ED data and 2,219 observations of opioid-related inpatient hospitalizations from 46 states and Washington, D.C., in the study. They did not identify a significant change in the rate of ED visits related to opioids during the study period for pre-2014 (3.98%; 95% CI, 14.69 to 6.72) or post-2014 (1.02%; 95% CI, 5.25 to 7.28) Medicaid expansions.
Regarding the rate of opioid-related inpatient hospitalizations, Wen and colleagues identified a –9.74% (95% CI, 18.83 to 0.65) reduction stemming from post-2014 Medicaid expansions.
The researchers noted that this reduction is equivalent to approximately 20 fewer opioid-related discharges per 100,000 population per year.
They also explained that the aggregate number of opioid-related hospitalizations in Medicaid expansion states from 2005 to 2013 was 96,728 per quarter in a total population of 180 million, implying that Medicaid expansion prevented 9,421 opioid-related hospitalizations per quarter.
Wen and colleagues noted that pre-2014 expansions that were made under the Health Insurance Flexibility and Accountability waiver and early ACA adoptions were not associated with the rate of opioid-related inpatient hospitalizations.
“Our study underscores the importance of Medicaid expansion in altering how patients with opioid use disorder interact with the medical system,” Wen and colleagues wrote. “To the extent that Medicaid expansion reduces avoidable hospitalizations, the expansion may be providing individuals with more patient-centered pathways into treatment.” – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.