Medicaid Unwinding Linked to Reduced Access to Buprenorphine

Johns Hopkins Bloomberg School of Public Health examined how Medicaid coverage losses during the 2023 Medicaid “unwinding” period and released their findings reviewing how patient access to buprenorphine was affected. Buprenorphine is a key medication for treating opioid use disorder (OUD). The study focused on Medicaid-insured adults and compared states with the largest drops in Medicaid enrollment to those with smaller decreases. It found that states with the largest losses saw significant declines in buprenorphine prescriptions—raising serious concerns about continuity of care during a time of ongoing overdose risk.

The researchers looked at national Medicaid data between January and December 2023, focusing on buprenorphine dispensing trends. In states with the highest drops in Medicaid enrollment (more than 10% decline), buprenorphine prescriptions fell by 7.7% after redeterminations resumed in April 2023. In contrast, states with the lowest enrollment declines (less than 2%) saw no significant change in prescriptions. This suggests that insurance instability during unwinding directly affects patients’ ability to access life-saving treatment.

The study, published in JAMA, emphasizes that Medicaid is the largest payer for OUD treatment in the U.S., and interruptions in coverage, even if temporary, can have immediate and dangerous consequences for individuals managing addiction. These coverage losses may lead to treatment disruptions, increased risk of relapses, and higher overdose rates, especially in communities already facing high opioid-related harm.

For behavioral health policy, these findings highlight the critical need for policies that protect access to OUD treatment during Medicaid transitions. State Medicaid agencies and health systems should prioritize streamlined reenrollment, automatic coverage renewals when possible, and outreach to individuals receiving OUD treatment. Ensuring continuous access to medications like buprenorphine must be a top priority to prevent avoidable overdose deaths and support long-term recovery.