In Georgia between 2010-2020, persons enrolled in substance use
treatment programs that prescribed methadone increased by 48.6%.

 

For beneficiaries who are eligible for both Medicare and Medicaid, Medicare paid for methadone treatment. Now, once the OTP is enrolled in Medicare , Medicare will become the primary payer for these beneficiaries. Medicare should continue to cover the service during the transition. Medicare Advantage plans should also allow coverage of OTPs that are not in their network while they assist beneficiaries in transitioning to an in-network OTP.

 

States that have Medicare funding for methadone treatment are far more likely than states without such funding to have Medicaid-enrolled patients in treatment programs, researchers have found. In 17 states, however, Medicare does not pay for methadone treatment.

For the study, ?Medicare Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction Treatment,? the researchers analyzed the 2012 Treatment Episode Data Set (TEDS) from the Substance Abuse and Mental Health Services Administration. They used a sample restricted to individuals who were covered by Medicare and admitted to treatment primarily for opioid use disorders.

In states with Medicare coverage for opioid agonist therapy, 45% of individuals enrolled in Medicare used the opioid agonist therapy, compared to 30.1% of individuals enrolled in Medicare in states with only Substance Abuse Prevention and Treatment (SAPT) block grant funding, and 17% of Medicaid-enrolled individuals in states with no public coverage.

Opioid agonist therapy is treatment with methadone or buprenorphine?the TEDS system does not distinguish between methadone and other opioid addiction treatment, but states do make this distinction. Both methadone and buprenorphine are effective, and buprenorphine is now covered in every state Medicare program, but methadone is not. Furthermore, Medicare funding for methadone treatment is already under fire in some states.