Alcohol Use Disorder Diagnosis and Medication Treatment Increased but Remain Low in Medicaid Managed Care

OBJECTIVE: As the largest payer of addiction treatment in the United States, Medicaid plays an important role in the delivery and quality of AUD treatment. However, little is known about AUD in the Medicaid managed care population, which consists of roughly 62 million adults. To address this literature gap, we examined diagnosis of AUD and receipt of medications for AUD (MAUD) among adult Medicaid managed care beneficiaries in 17 states. METHOD: We used Medicaid claims data from 17 states to identify AUD diagnosis and receipt of MAUD (2017-2019). We used logistic regression with state fixed effects to identify characteristics of Medicaid managed care beneficiaries associated with AUD diagnosis and receipt of MAUD. RESULTS: Over the study period, the percentage of beneficiaries with an AUD diagnosis increased from 2.7% in 2017 to 3.0% in 2019 (11.1% increase), and the percentage receiving MAUD increased from 6.5% to 9.3% (43.1% increase). Results also showed substantial variation in AUD diagnosis, MAUD receipt, and type of MAUD prescribed across states. The odds of having an AUD diagnosis were lower for female and non-White beneficiaries, while the odds were higher for older beneficiaries and beneficiaries with a substance use disorder diagnosis. Results predicting MAUD receipt were similar. CONCLUSIONS: While only 9.3% of beneficiaries with an AUD diagnosis received MAUD in 2019, receipt of MAUD increased by 43.1% during study period, signaling substantial growth in access. Overall, our findings suggest that greater efforts are needed to identify and treat AUD in the Medicaid managed care population.