Medicaid Expansion: A Key Lifeline in Increasing Access to Treatment for Opioid Disorders

A closer look at the latest HealthChoices claims data from 2018 reinforces how critical Medicaid Expansion has been to fighting the opioid epidemic and ensuring individuals in Allegheny County can get the care they need to overcome substance use disorder and support recovery. Each of the bar charts shows service or diagnosis data for 2018. To view this data from previous years, click on the "Year" button in the top right corner and select from the dropdown menu which year(s) you would like to see included the graph.

Non-Hospital Rehabilitation Tops List of HealthChoices Paid Claims in 2018

HealthChoices facilitates access to treatment for opioid use disorders by covering numerous inpatient and outpatient treatment services, as well as medications prescribed as part of medication-assisted treatment. In 2018, for the first time in the 20 year history of the program, a substance use disorder (SUD) service ranked number one in terms of paid claims. Non-hospital rehabilitation (NH-Rehab), which has historically ranked near the top of services in terms of total spending, finally surpassed inpatient mental health services. NH-Rehab accounted for nearly 14 percent of Allegheny County's HealthChoices paid claims in 2018.

The Impact of Opioid Diagnoses

In 2018, 4,174 HealthChoices members utilized NH-Rehab services, and over 2,200 had a diagnosis related to opioid use disorder*. Each year since 2010, members with an opioid use disorder utilized NH-Rehab more than any other diagnosis category. In 2016, this group of members increased by 28% and remained at similar level through 2018. This sustained increase contributed to NH-Rehab having the highest volume of paid claims.

*members can have more than one diagnosis

Medicaid Expansion Members Disproportionately Utilize Substance Use Disorder Services

Understanding the growth in NH-Rehab paid claims requires a closer look at the service utilization of HealthChoices members eligible under the Medicaid Expansion, enacted in 2015. (For more information on Medicaid Expansion, please see AHCI’s 2017 report available here.)

While 2018 was the first year that NH-Rehab topped the list of spending by service in Allegheny County, it has been the top service for the Medicaid Expansion population since the program was enacted in 2015. In fact, at least half of the Medicaid Expansion spending has been in substance use disorder related services, a distinct difference than those enrolled in traditional HealthChoices eligibility categories.

Almost any way the data is cut, the Medicaid Expansion population stands out as disproportionate users of NH-Rehab services:

  • Compared to 14 percent of all HealthChoices spending on behavioral health services in 2018, NH-Rehab accounted for just under 30 percent of total spending on behavioral health services for the members eligible under Medicaid Expansion. This compares to just 7 percent of total spending for the members eligible under Traditional Medicaid.

  • While HealthChoices members eligible under Medicaid Expansion represented about a third of all service users in 2018 (32 percent), they accounted for roughly 2 of every 3 NH-Rehab service users (69 percent).

  • HealthChoices members eligible under Medicaid Expansion accounted for just under 30 percent of total spending on behavioral health services in 2018. Yet of the total amount paid for NH-Rehab services, 63 percent was paid for services by Medicaid Expansion members.

Access to treatment such as NH-Rehab is critical to fighting the opioid epidemic. AHCI will continue to monitor and report on issues related to Medicaid Expansion and County efforts to curtail the opioid crisis.