Cascade of Care for Opioid Use Disorder Among Medicaid Beneficiaries

Importance: Opioid use disorder (OUD) is a major cause of death and disability among Medicaid beneficiaries. Understanding progress on engaging Medicaid beneficiaries in effective treatment is vital for reducing burden. Objective: To examine changes over time and state variation in rates of OUD diagnosis, receipt of medications for OUD (MOUD), MOUD continuity, and OUD-related hospitalization or emergency department (ED) visits among Medicaid beneficiaries. Design, setting, and participants: This repeated cross-sectional study used 2018-2023 Medicaid claims data for measurement years 2019 to 2023. The study included non-dual eligible Medicaid beneficiaries aged 18 to 64 years residing in 47 states and the District of Columbia. The data analyses were performed between July 1 and December 11, 2025. Exposure: Medicaid coverage. Main outcomes and measures: The main outcome was the percentage of Medicaid beneficiaries with (1) an OUD diagnosis, (2) MOUD, (3) MOUD continuity for at least 180 days, and (4) OUD-related hospitalization or emergency department visit. Results: Among 126 430 422 Medicaid beneficiary-year observations (aged 35-64 years range, 47.7%-52.3%; female range, 59.5%-61.2%), the percentage diagnosed with OUD declined from 4.2% in measurement year 2019 to 3.6% in measurement year 2023 and declined in 34 states. The percentage of all Medicaid beneficiaries with OUD who received MOUD increased from 60.0% to 69.1% and increased in 45 states. The percentage of Medicaid beneficiaries who continued MOUD for at least 180 days decreased from 62.6% to 57.6% and decreased in 29 states. The percentage of beneficiaries with OUD who had an OUD-related hospitalization or ED visit decreased from 10.9% to 10.6% but increased in 31 states. Conclusions and relevance: This cross-sectional study found a substantial increase in the percentage of individuals with OUD who received MOUD among almost all states. The increase in MOUD use may have contributed to reductions in overdose deaths, but more research is needed.