Medicare users have less accessibility to SUD treatment compared with other payment forms

Medicare beneficiaries have less geographic accessibility to substance use disorder treatment facilities, as Medicare acceptance is lower compared with other kinds of payment, per a study published in JAMA Network Open.

“The number of older adults receiving treatment for opioid use disorder has almost doubled since 2007,” Jonathan H. Cantor, PhD, of the RAND Corporation, and colleagues wrote. “Two of the most commonly cited reasons for not receiving care were related to access: limited affordability and limited availability of treatment.”

Cantor and colleagues wanted to assess whether geographic accessibility of services was limited for older adults despite the increasing need for SUD and opioid use disorder treatments in this population.

Their longitudinal cross-sectional study obtained data on 11,709 licensed SUD treatment facilities across the U.S. per year between 2010 and 2021. Included in the analysis were the national proportion of treatment facilities accepting Medicare, Medicaid, private insurance or cash as a form of payment, the proportion of counties with a treatment facility accepting each form of payment and the proportion of the U.S. population with Medicare, Medicaid, private insurance or cash payment residing within a 15-, 30-, or 60-minute drive from an SUD treatment facility accepting their form of payment in 2021.

Results showed that cash was the most accepted form of payment (91% in 2010 to 91.6% by 2021), followed by private insurance (63.5% to 75.3%), Medicaid (54% to 71.8%), and Medicare (32.1% to 41.9%). The proportion of counties with a treatment facility that accepted Medicare as a form of payment also increased over the same study period, from 41.2% to 53.8%, with the proportion of counties with a facility that accepted Medicaid as a form of payment increased from 53.5% to 67.1%.

Data additionally revealed the proportion of Medicare beneficiaries with a treatment facility that accepted Medicare as a form of payment within a 15-minute driving time increased from 53.3% to 57%. The proportion of individuals with a treatment facility within a 15-minute driving time that accepted their respective form of payment was 73.2% for those with Medicaid, 69.8% for those with private insurance and 71.4% for those with cash payment in 2021.

“Policymakers should consider increasing reimbursement rates and using additional incentives to encourage the acceptance of Medicare by SUD treatment facilities,” Cantor and colleagues wrote.