Date of Award
Master of Public Health (MPH)
School of Public Health
Background: In 2015, the Centers for Medicare and Medicaid Services (CMS) issued guidelines for a Medicaid Section 1115 behavioral health waiver with the intention of improving access to treatment for individuals with substance use disorder (SUD). One provision of the waiver allowed states to lift federal guidelines that originally prohibited states from using Medicaid funds to reimburse adults aged 21-64 years old for SUD services that occurred at “institutions for mental disease” (IMDs) with more than 16 beds. As of February 2021, 31 states have an approved the waiver.
Objective: To determine whether the Section 1115 SUD waivers, originally issued in 2015 but implemented at varying dates among the states, changed outpatient Medicaid population utilization of buprenorphine and naltrexone.
Methods: Using the Medicaid State Drug Utilization Dataset, three separate difference-in- differences models were applied on four treatment states and four control states. Treatment states included Virginia, California, Massachusetts, and New Jersey, all of which adopted the Section 1115 behavioral health waiver in 2017. Control states included Maine, Arizona, Colorado, and Tennessee, all of which have a pending SUD waiver as of August 2020.
Results: After applying a successful parallel trends test, all models revealed an insignificant change in levels of buprenorphine and naltrexone prescriptions in SUD waiver states. For buprenorphine, the coefficients of interest in the primary difference-in-differences model (p = .576, 95% CI [-0.0497 ± 0.177]), the fixed effects model containing only treatment states (p = .894, 95% CI [0.00117 ± 0.175]), and the fixed effects model containing both treatment and control states (p = .372, 95% CI [-0.0464 ± 0.103]) were all insignificant. For naltrexone, the coefficients of interest in the primary difference-in-differences model (p = .599, 95% CI [0.0968 ± 0.367]), the fixed effects model containing only treatment states (p = .728, 95% CI [-0.0531 ± 0.303]), and the fixed effects model containing both treatment and control states (p = .234, 95% CI [0.0838 ± 0.140]) were all insignificant.
Conclusion: The 2015 Section 1115 SUD waivers did not change outpatient buprenorphine and naltrexone utilization levels in the Medicaid populations in Virginia, California, Massachusetts, and New Jersey relative to the selected control states.
Cai, Evangeline, "Effects Of Substance Use Disorder Section 1115 Waivers On Medicaid Population Utilization Of Buprenorphine And Naltrexone" (2021). Public Health Theses. 2027.