(1078) Impact of Changing Medicaid Coverage for Methadone on Opioid Use Disorder Treatment in Pregnancy

This is a cross-sectional study using linked South Carolina claims and birth certificate data (2015 to 2022) of live births with a diagnosis of opioid use disorder (OUD) in pregnancy. We divided our population into 2 cohorts: 1) before and 2) after the state’s Medicaid approval for methadone coverage on January 1st 2019. Our primary outcome was receipt of medication for OUD (MOUD) during pregnancy or within the first 60 days postpartum. Using standard bi-variate tests, we compared the pre- and post-policy rates of Methadone of MOUD as well as demographic factors between each group. 

Results:

In total, 2,633 patients with OUD were included in our study. Of these, 1181 delivered prior to Medicaid approval of methadone and 1,452 were in the post-approval cohort. Following Medicaid approval for methadone, there was a statistically significant increase in the number of methadone prescriptions within the Medicaid population (p < 0.001) and a near significant increase of individuals receiving methadone as MOUD (5.1% vs 9.1%, p=0.06). There was a statistically significant increase in those receiving any MOUD post-coverage (34.8% vs 47.2%, p < 0.001). Those who did not receive Methadone or any MOUD were more likely to be under the age of 25 (57.2%) and live in a rural county (59.9%).  

Conclusion: Our results show that changing Medicaid coverage for methadone increases overall treatment for OUD in pregnancy. However, there continue to be gaps in treatment connections for individuals < 25 years of age and from rural counties. As the opioid epidemic increases, improving access to medication coverage for OUD and focusing efforts on younger, more rural areas may impact OUD treatment in pregnancy, and subsequently, maternal mortality.