Alcohol treatment in Medicaid managed care plans: Disparities in policies and outcomes

Almost 90,000 Americans die annually from alcohol use. Rates of alcohol-related morbidity and mortality are disproportionately high and increasing. Despite the health consequences, fewer than 10% of those with alcohol use disorder (AUD) receive evidence-based treatment. Barriers to treatment include stigma, treatment setting appeal, and health insurance benefit design. Medicaid provides health insurance for more than 77 million Americans, and rates of AUD are especially high in the Medicaid population. Almost all state Medicaid programs contract with Medicaid managed care organizations (MMCOs) to deliver and manage health care services. MMCOs must adhere to state requirements and policies but have considerable discretion over polices that may influence access, treatment appeal, and cost. However, there is almost no information or transparency on MMCO polices related to alcohol treatment services. This study systematically examines AUD treatment policies in MMCOs, an under-explored level where important decisions are made. We will conduct a national survey of MMCOs and link their responses to patient-level Medicaid data. The specific aims are: 1) Assess Medicaid MMCO alcohol treatment policies (e.g. coverage, utilization management, provider networks, innovations) across MMCOs that contract with 50 states and the District of Columbia; evaluate whether there are differences in MMCO alcohol treatment policies by state Medicaid policies. 2) Evaluate the relationship between MMCO policies and access to AUD treatment (e.g. initiation and engagement in treatment, follow-up after hospitalization). 3) Evaluate the relationship between MMCO policies and alcohol treatment outcomes (e.g. treatment retention, hospitalization, ED visit). Our interdisciplinary team is uniquely qualified with experience conducting rigorous analyses and conducting four previous commercial health plan behavioral health studies. Findings will provide valuable information on MMCO policies associated with access, treatment appeal and cost for all Americans. This information can be used by plan administrators as they develop and implement policies, state Medicaid directors as they contract with and regulate MMCOs, and federal policy makers making determinations about Medicaid waivers and other efforts to improve access to alcohol treatment in the US.