Presentation (CTI)

OBJECTIVES: Dual-eligible Medicare-Medicaid beneficiaries with opioid use disorder (OUD) are an understudied population due to challenges in linking claims data and a vulnerable population due to social disadvantage in accessing medications for OUD (MOUD) and behavioral health (BH) therapy. We examined patterns of MOUD and BH initiation among dual-eligible beneficiaries following an OUD diagnosis, overall and by Medicare entitlement, and assessed differences by data source.
METHODS: We linked national Medicaid and Medicare administrative claims (2010-2018) and identified dual-eligible beneficiaries with an incident OUD diagnosis (index date). Dual eligibility was assessed in the month of the index date. Beneficiaries aged ≥18 years were included if they had continuous Medicare-Medicaid enrollment for six months prior to first diagnosis claim (baseline) and three months following diagnosis (follow-up), with no evidence of MOUD or OUD remission during baseline. Initiation of BH and MOUD during follow-up was identified using linked Medicare-Medicaid claims and Medicare or Medicaid claims alone.
RESULTS: The cohort included 43,949 dual-eligible beneficiaries with OUD. Overall, 90.17% initiated BH during follow-up whereas only 1.99% initiated MOUD. Among those initiating MOUD, the median time to initiation was 6 days (IQR: 1-19 days). Beneficiaries entitled to Medicare based on age had significantly lower initiation rates of BH and MOUD compared with those entitled based on disability (p < 0.001). Analyses relying on single claims source underestimated treatment initiation, with highest initiation identified using linked claims. Medicare claims captured most buprenorphine, naltrexone and BH utilization; however, 162 individuals initiated methadone only captured in Medicaid claims, as methadone was not covered by Medicare during study period.
CONCLUSIONS: MOUD initiation among dual-eligible beneficiaries with OUD remains low, particularly among those entitled to Medicare based on age. Findings underscore the need to address factors contributing to undertreatment and highlight the importance of linked Medicare-Medicaid data for comprehensively assessing OUD treatment in this population.