Insurance instability is a significant issue for individuals diagnosed with opioid use disorder (OUD). This condition often leads to transitions in insurance coverage, which can disrupt access to essential medications and treatment services. This article delves into the findings of a comprehensive cohort study that examined the incidence of insurance transitions among patients with newly diagnosed OUD covered by Medicaid or commercial insurance.

Study Design and Data Source

The study utilised data from the Massachusetts Public Health Data Warehouse, focusing on adults aged 18 to 63 years diagnosed with OUD between July 1, 2014, and December 31, 2014. The primary outcome was the cumulative incidence of insurance transitions in the 12 months following diagnosis. The study also estimated the probability of these transitions across various sociodemographic groups.

Baseline Characteristics

The cohort consisted of 20,768 individuals diagnosed with incident OUD during the study period. The majority (75.4%) were covered by Medicaid, while the rest had commercial insurance. Most individuals with OUD were male (78.4% with Medicaid and 87.4% with commercial insurance). The racial and ethnic composition varied, with a higher percentage of non-Hispanic White individuals in both insurance categories.

Incidence of Insurance Transitions

In the first 12 months post-diagnosis, 30.4% of patients experienced an insurance transition. The incidence was slightly higher for those with Medicaid (30.7%) compared to those with commercial insurance (29.4%). The most common type of transition was to the uninsured/missing category, affecting 16.7% of commercial insurance holders and 24.4% of Medicaid recipients.

Estimators of Insurance Transitions

The adjusted probability of experiencing an insurance transition was 31.3% for Medicaid recipients and 27.9% for those with commercial insurance. Younger individuals, particularly those aged 18-24 years with Medicaid (39.0%) and those aged 26-35 years with commercial insurance (37.5%), were more likely to experience transitions. Racial and ethnic disparities were also evident, with Black non-Hispanic individuals with commercial insurance having the highest probability of insurance transitions (40.1%).

Impact of Medication for Opioid Use Disorder (MOUD)

Starting MOUD within 30 days of diagnosis was associated with a lower probability of insurance transitions for Medicaid recipients (27.0% for those starting MOUD vs. 32.5% for those not starting MOUD). However, this association was not observed among those with commercial insurance.

Sensitivity Analyses

Several sensitivity analyses were conducted to validate the findings:

• Allowing a 1-month lapse in insurance coverage reduced the transition rates more for Medicaid recipients (23.5%) than for those with commercial insurance (27.4%).
• Nearly 50% of Medicaid recipients who transitioned to the uninsured/missing category re-enrolled in Medicaid within 12 months, compared to only 20% of commercial insurance holders.
• An expanded cohort including data through March 2020 showed lower transition rates for Medicaid recipients (28.3%) and higher rates for commercial insurance holders (34.0%).

Comparisons with Type 2 Diabetes (T2D) Cohort

The study included a propensity score–matched cohort of individuals diagnosed with type 2 diabetes (T2D) to provide context. Patients with OUD had higher rates of insurance transitions compared to those with T2D, particularly among commercial insurance holders (26.8% for OUD vs. 17.5% for T2D).

Discussion and Implications

The high rates of insurance transitions among individuals with OUD highlight a critical issue that may affect their treatment outcomes. Younger individuals and racially minoritised groups, particularly those with commercial insurance, are at higher risk of experiencing insurance instability. These transitions can disrupt access to essential MOUD, thereby impacting treatment retention and overall health outcomes.

Conclusion

Insurance transitions are common among individuals with newly diagnosed OUD, with one-third experiencing a transition in the first year post-diagnosis. Addressing insurance instability is crucial to improving treatment access and outcomes for this vulnerable population.Source: JAMA Health Forum