Medicaid Coverage for Methadone

Medicaid Coverage for Methadone

An opioid epidemic exists in the US and the government is making it a priority. The FDA is partnering with a number of other government agencies to implement significant changes that it hopes will bring this epidemic under control. They are calling for tougher guidelines on how opioids are approved, labeled, and prescribed, and they are supporting the increased use of medications to help opioid addicted people quit – such as methadone, naloxone/naltrexone, and buprenorphine.

Recovery Services of New MexicoMethadone is an opioid agonist and, for decades, has been the gold standard for helping people addicted to opiates wean themselves off of their opioid of choice. In previous decades, this drug of choice was nearly always heroin, but these days, it can be any number of things and prescription pain pill abuse is on the rise. The use of opioid agonist therapy, or OAT, helps patients manage cravings, eliminates symptoms of withdrawal, and reduces the need for opiates. And there are secondary public health benefits too. Weaning addicts off of injection drug use means fewer cases of dangerous infections, such as Hepatitis C and HIV.

Although increasing numbers of physicians are being approved to prescribe buprenorphine, which has a somewhat more favorable safety profile than methadone, methadone is commonly and safely used in opioid treatment programs. Of all the OATs, methadone is by far the least expensive and most familiar.

A recent study was done to look more closely at OAT utilization by Medicaid patients in states with three different funding situations: states with public funding for methadone, states with more restrictive grant funding for methadone, and states with no public funding. Not surprisingly, the difference funding made in the percentage of Medicaid patients accessing addiction treatment or OAT was astronomical: nearly 47% in states with publically funded programs, 27% in those with more restricted funding programs, and only 7% when there was no public funding.

There is concern that the potential elimination of methadone funding, and the closing of some clinic programs–at a time when there aren’t enough–will leave a significant number of opioid addicted/Medicaid insured essentially stranded. There is concern that states without methadone programs will see an overall drop in all OAT utilization and a corresponding increase in morbidity and mortality.

The number of methadone treatment programs currently available is insufficient to meet the need, yet there is talk of pulling funding in some of the states with programs. Right now, seventeen states do not have a funding program and that number may goRecovery Services of New Mexico up. Buprenorphine is a covered benefit in every state, but it is typically handed out as a prescription, not administered in a clinic setting where there is a lot of patient support. It does not make sense that in a healthcare crisis of epidemic proportions, funding withdrawals may translate into the closure of addiction clinics that serve the low income population.

Recovery Services is the largest and most effective opioid addiction treatment organization in New Mexico. We want to help and offer treatment for opioid addiction with methadone, buprenorphine, and naltrexone. Please contact us if you, or a loved one, are addicted to opioids.



Saloner B, Stoller KB, Barry CL.Medicaid Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction Treatment. Psychiatry Serv. 2016 Feb 29:appips201500228. PMID: 26927578

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