As the largest payer of substance use disorder (SUD) services, Medicaid plays a key role in SUD treatment delivery in the United States. Insurers reimburse SUD services at lower rates than many other healthcare services, and rates are lowest in Medicaid relative to Medicare or commercial insurance. Low payment disincentivizes clinicians from specializing in addiction and limits the volume of Medicaid patients treated. Growing interest in implementing and evaluating improved Medicaid payments is stymied by complex payment methodologies and limited data. 

This study aims to understand how states set Medicaid payment rates for substance use disorder providers and explores the utility of publicly available data for characterizing rates.

Researchers conducted qualitative interviews with state leaders with Medicaid expertise in seven select states. Key findings include:

• States have heterogeneous and opaque processes for setting Medicaid SUD provider payment rates.
• Published Medicaid fee schedules often do not reflect the full payments providers receive.
• Data on Medicaid SUD payments, particularly payments through managed care, are not consistently publicly available.
   

Authors found that state processes for SUD payment rate setting vary widely and published fee schedules have limited utility for interpretation of actual SUD provider payment. Improved transparency is needed to study whether and how changing Medicaid provider payments can improve SUD treatment access and patient outcomes.