Substance Use Disorders

Substance Use Disorders (SUD) impact the lives of millions of Americans in the general population, including individuals that are enrolled in the Medicaid program. Nearly 12 percent of Medicaid beneficiaries over 18 have a SUD, and CMCS is committed to helping States effectively serve individuals with SUDs. On average, 105 people die every day as result of a drug overdose. Additionally, 6,748 individuals across the country seek treatment every day in the emergency department for misuse or abuse of drugs. In 2010, drug overdose was the leading cause of injury death and caused more deaths than motor vehicle accidents among individuals 25-64 years old. The monetary costs and associated collateral impact to society due to SUDs are very high. In 2009, health insurance payers spent $24 billion for treating SUDs. Of the $24 billion, Medicaid accounted for 21 percent of the spending. The evidence is strong that treatment in managing SUDs provides substantial cost savings. For instance: 

  • Persons with untreated alcohol use disorders use twice as much health care and cost twice as much as those with treated alcohol use disorders; and medications treating substance use disorder in pregnant women resulted in significantly shorter hospital stays than drug-addicted pregnant women not receiving MAT (10.0 days vs. 17.5 days).
  • For inpatients with alcohol dependence, MAT was associated with fewer inpatient admissions. Total healthcare costs were 30 percent less for individuals receiving MAT than for individuals who not receiving MAT.
  • Medical costs decreased by 30 percent on average between the year prior to MAT and the third year following treatment, and these cost trends reflect a decline in expenditures in all types of health care settings including hospitals, emergency departments, and outpatient centers.
  • Methadone treatment has been found to generate $4 to $5 in returns on healthcare expenditures for every $1 invested.
  • Early intervention in the cycle of addiction for younger individuals with substance use disorders can bring costs down as they have lower pre-treatment costs than older adults with substance use disorders.

CMS is encouraged with the increased interest by states to develop effective strategies for developing benefit designs for this population. Many states have included behavioral health services for individuals with SUD in the State Plans and various Medicaid managed care Waivers. The following resources are available to States:

Coverage and Deliver of Adult Substance Abuse Services in Managed Care

This issue brief explores state strategies with respect to purchasing substance abuse services for adult Medicaid beneficiaries, with a particular focus on states that use man­aged care for the purchase and delivery of physical health services. The brief reviews the current landscape of substance abuse coverage in Medicaid managed care states and the paradigm shift created by the ACA Medicaid expansion in terms of substance abuse eligibility, benefits, and provider capacity. A webinar on this topic was held on September 24, 2014.