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State Regulation of SUD Treatment In Medicaid Managed Care

Managed care plans contract with state Medicaid programs to administer substance use disorder (SUD) treatments. 

In the July issue of Health Affairs, Lauren A. Peterson of the University of Chicago and her team of coauthors survey thirty-three states and Washington, DC, to determine the role these states play in regulating the distribution of SUD benefits across Medicaid managed care plans.

The researchers find that of the fifty-one programs examined, “high percentages of state programs mandated coverage for each of the SUD treatments and medications assessed.” 

Despite this, "only 50 percent (sixteen of the thirty-two state programs) that contracted with managed care plans to administer SUD treatment services required coverage of all clinically necessary services…”

Peterson and coauthors conclude that while many state Medicaid programs require managed care plans to cover the most common SUD treatment services, limits on comprehensive coverage remain, which might restrict access to lifesaving SUD services.

More On Managed Care

• Quantifying The Economic Burden Of Drug Utilization Management On Payers, Manufacturers, Physicians, And Patients by Scott Howell et al.
  
  
• Once A Welfare Add-On, Medicaid Takes Charge In Reinventing Care by Rob Cunningham
  
  
• Forefront: Physicians’ Broader Vision For The Center For Medicare And Medicaid Innovation's Future: Look Upstream by Walker Ray and Tim Norbeck
  
  
• A Health Podyssey: Jane Zhu on Narrow Networks in Medicare Advantage Plans

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