Treatment access for opioid use disorder among women with medicaid in Florida

• Published in: Drug and alcohol dependence Vol. 246; p. 109854
• Main Authors: Elmore, Amanda L., Patrick, Stephen W., McNeer, Elizabeth, Fryer, Kimberly, Reid, Chinyere N., Sappenfield, William M., Mehra, Saloni, Salemi, Jason L., Marshall, Jennifer
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2023
• Subjects: Access; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; Female; Florida - epidemiology; Humans; Medicaid; Methadone; Methadone - therapeutic use; Opiate Substitution Treatment; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - therapy; Pregnancy; Pregnancy status; Treatment; United States; Women; Florida; United States; Women; Treatment; Buprenorphine; MOUD; Access; BWP; OTP; Methadone; Opioid use disorder; SAMHSA; Pregnancy status; OUD
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2023.109854

Opioid use disorder (OUD) remains prevalent. Medications for OUD (MOUD) are standard care for pregnant and non-pregnant women. Previous research has identified barriers to MOUD for women with Medicaid but did not account for the type of MOUD (methadone vs. buprenorphine) or pregnancy status. We examined access to MOUD by treatment type for pregnant and non-pregnant women with Medicaid in Florida. A secondary analysis of Florida “secret-shopper” data was conducted. Calls were made to clinicians from the 2018 Substance Abuse and Mental Health Services Administration provider list by women posing as either a pregnant or non-pregnant woman with OUD and Medicaid. We examined 546 calls to buprenorphine-waivered providers (BWP) and 139 to opioid treatment programs (OTP). Counts and percentages were used to describe caller success by type of treatment and pregnancy status. Chi-square tests were used to identify statistical differences. Only 42 % of calls reached a treatment provider in Florida. Pregnant and non-pregnant women were less likely to obtain an appointment with Medicaid coverage by a BWP than an OTP (p < 0.01). Nearly 40 % of OTPs offered appointments to callers with Medicaid compared to only 17 % of BWPs. Both types of providers denied appointments more often for pregnant women. Thirty-eight percent of BWP’s and 12 % of OTP’s denied appointments to pregnant women using cash or Medicaid payment. Our study demonstrates logistical and financial barriers to treatment for OUD among pregnant and non-pregnant women with Medicaid in Florida and highlights the need for improved systems of care. •Only 42 % of calls reached a treatment provider on the phone (35 % BWP, 70 % OTP).•Over 50 % of calls that reached a provider were asked to pay cash for treatment.•BWPs were significantly less likely to accept Medicaid payment than OTPs.•Less than 1 in 5 women were accepted for buprenorphine treatment using Medicaid.•BWPs and OTPs denied appointments more often for pregnant women.