A Comprehensive Listing of What States Cover for Substance Use Disorder, including Medications

• NCJ Number: 300911
• Date Published: May 2021
• Grant Number(s): 2016-MU-BX-K021
• Agencies: BJA

Annotation

This is an update as of October 2019 of each U.S. state’s authorized Medicaid coverage for medicines used to treat substance abuse disorders (SUDs).

Abstract

This report presents all information on a state’s covered SUD services and Medicaid prescription drug formularies or preferred drug lists as of October or November 2019, with most states providing preferred drug lists (PDLs) effective as of October or November 2019. Many states are either implementing newly approved programs or are awaiting approval for changes they have proposed and submitted to the Center for Medicare and Medicaid Services (CMS), the federal agency that oversees state Medicaid programs and approves state plans and modifications or service delivery reforms under waiver programs. The provisions of pending waivers that would result in changes to Medicaid services or eligibility requirements are discussed if such information is available. Only one state’s work requirements for Medicaid recipients have been implemented (Indiana); however, five other states have been approved to have work requirements that have not yet been implemented (Arizona, Michigan, Ohio, Utah, and Wisconsin). The courts have set aside work requirements in New Hampshire, Kentucky, and Arkansas, but at least 10 other states have pending submissions that include such requirements. The positive trends that continue to expand to more states include adding methadone assisted treatment to covered Medicaid services. In other states, Medicaid funds can be used to pay for some services offered by opioid treatment programs, including medical exams and counseling, but cannot pay for medication. In most states that do not provide coverage for methadone treatment through Medicaid, federal opioid funds have been earmarked to provide for medicine-assisted treatment to people without insurance or whose insurance does not cover it.