Telehealth and disparities in opioid use disorder treatment: Medicaid enrollees versus privately insured individuals

Objective

To determine how the rise of telehealth during the COVID-19 pandemic impacted Medicaid enrollees' access to opioid use disorder (OUD) treatment.

Data Sources and Study Setting

Electronic health records from Northwestern Medicine, a large midwestern academic health system, from January 1, 2019 to December 31, 2021.

Study Design

The exposure was the expansion of telehealth services during the COVID-19 pandemic. A difference-in-differences design was used to determine the impact of telehealth on the probability of receiving any OUD care, any in-person OUD care, and any telehealth OUD care in a month.

Data Collection/Extraction Methods

The study included Medicaid and privately insured patients older than 18 years of age, diagnosed with OUD, who had any encounter with the Northwestern Medicine system. All outpatient visits with OUD as the primary diagnosis were included in the analysis. There were 486 individuals in the sample and 17,496 person-month observations.

Principal Findings

After the onset of the COVID-19 pandemic, Medicaid enrollees are 4.5 percentage points (percentage change, 43.7%; 95% confidence interval [CI] 8.7 to 0.3 percentage points; p = 0.035) less likely to receive any OUD care in a month, relative to privately insured patients. While no statistically significant differences in the likehood of receiving in-person OUD care were detected between the groups after exposure, we did observe that Medicaid enrollees are 3.6 percentage points (percentage change 64.2%; 95% CI 6.0 to 1.1 percentage points; p = 0.004) less likely to receive any telehealth OUD care in a month relative to privately insured patients.

Conclusions

While those with private insurance were able to maintain OUD treatment during the pandemic by supplementing in-person care with telehealth, Medicaid enrollees experienced a drop in overall OUD treatment rates due to lower telehealth use. The rise of telehealth for OUD treatment might contribute to widening care gaps for Medicaid enrollees.