Publications · 2025
Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures, 2012–22
Health Affairs , 44(9):1122-1130 , 2025 · doi:10.1377/hlthaff.2025.00348
Overview
After Medicaid Section 1115 waivers let states pay for residential addiction treatment, facilities in waiver states became 26 percentage points more likely to both accept Medicaid and offer FDA-approved opioid use disorder medications. Notably, nearly 90% of the access improvement came not from existing facilities changing their practices but from new facilities opening and others closing. Policy designs and evaluations that ignore market entry and exit may under- or over-predict their own effects.
Abstract
Starting in 2015, states could access previously restricted Medicaid funds for residential addiction treatment through Medicaid Section 1115 waivers, contingent on new requirements. Using facility-level survey data and a quasi-experimental difference-in-differences framework, we describe changes in Medicaid patients' access to medications for opioid use disorder (MOUD) in residential addiction treatment facilities during the period 2012-22 and assess the role of facility turnover in these outcomes. Four years after the policy took effect, facilities in six intervention states that adopted the waivers were 26 percentage points more likely to accept Medicaid patients and provide MOUD relative to nineteen control states. Most of the increase (89 percent) was driven by differences in facility entry and exit. Intervention states experienced significant facility turnover in the residential treatment market after the policy was implemented; entrants were more likely to have MOUD available for Medicaid beneficiaries, whereas facilities that did not provide MOUD were more likely to exit. Among continuously operating facilities, Medicaid participation improved, but MOUD availability did not. These findings highlight the fact that provider entry and exit have the potential to accelerate policy effects.
Recognition & impact
Awards4
- 2025 Team Science Research Award (2026)Yale School of Public Health
- Early Career Investigator Award (2024)Addiction Health Services Research Conference
- Early Investigator Outstanding Paper Award (2024)Health Economics Interest Group, AcademyHealth Annual Research Meeting
- Early Career Investigator Award (2024)Quality and Value Interest Group, AcademyHealth Annual Research Meeting
Media2
- Insights about the opioid crisisHealth Affairs Event
- Medicaid reimbursement boosts access to opioid treatment at new facilitiesYSPH News
Topics
- Medicaid
- Section 1115 waiver
- MOUD
- residential treatment
- facility entry and exit
- industrial organization
- difference-in-differences
- health policy
How to cite
Beetham T, Newton H, Ndumele C, Fiellin DA, Busch S. Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures, 2012–22. Health Affairs, 44(9):1122-1130; 2025. doi:10.1377/hlthaff.2025.00348
Show BibTeX
@article{beetham2025medicaidincreased,
title = {{Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures, 2012–22}},
author = {Beetham, T. and Newton, H. and Ndumele, C. and Fiellin, D. A. and Busch, S.},
journal = {Health Affairs},
year = {2025},
volume = {44},
number = {9},
pages = {1122--1130},
doi = {10.1377/hlthaff.2025.00348},
url = {https://doi.org/10.1377/hlthaff.2025.00348},
abstract = {Starting in 2015, states could access previously restricted Medicaid funds for residential addiction treatment through Medicaid Section 1115 waivers, contingent on new requirements. Using facility-level survey data and a quasi-experimental difference-in-differences framework, we describe changes in Medicaid patients' access to medications for opioid use disorder (MOUD) in residential addiction treatment facilities during the period 2012-22 and assess the role of facility turnover in these outcomes. Four years after the policy took effect, facilities in six intervention states that adopted the waivers were 26 percentage points more likely to accept Medicaid patients and provide MOUD relative to nineteen control states. Most of the increase (89 percent) was driven by differences in facility entry and exit. Intervention states experienced significant facility turnover in the residential treatment market after the policy was implemented; entrants were more likely to have MOUD available for Medicaid beneficiaries, whereas facilities that did not provide MOUD were more likely to exit. Among continuously operating facilities, Medicaid participation improved, but MOUD availability did not. These findings highlight the fact that provider entry and exit have the potential to accelerate policy effects.},
keywords = {Medicaid; Section 1115 waiver; MOUD; residential treatment; facility entry and exit; industrial organization; difference-in-differences; health policy},
note = {Awards: 2025 Team Science Research Award (2026), Yale School of Public Health; Early Career Investigator Award (2024), Addiction Health Services Research Conference; Early Investigator Outstanding Paper Award (2024), Health Economics Interest Group, AcademyHealth Annual Research Meeting; Early Career Investigator Award (2024), Quality and Value Interest Group, AcademyHealth Annual Research Meeting. Media coverage: Insights About The Opioid Crisis — Health Affairs Event (2025), YSPH News}
}