State drug caps associated with fewer Medicaid-covered prescriptions for opioid use disorder, 2017-2022.

The Medicaid program is the largest payer of opioid use disorder (OUD) treatment, including medications for OUD (MOUD). Because of budget neutrality requirements, some Medicaid programs use prescription drug caps to limit the monthly number of prescriptions an enrollee can fill. This study examined the association between Medicaid prescription drug caps and Medicaid-covered prescriptions for 2 forms of MOUD (buprenorphine and naltrexone) from 2017 to 2022 using fee-for-service and managed care data from Medicaid's State Drug Utilization Data.

Changes in Postpartum Opioid Prescribing After Implementation of State Opioid Prescribing Limits.

Importance: In response to the growing opioid crisis, states implemented opioid prescribing limits to reduce exposure to opioid analgesics. Research in other clinical contexts has found that these limits are relatively ineffective at changing opioid analgesic prescribing.

Objective: To examine the association of state-level opioid prescribing limits with opioid prescribing within the 30-day postpartum period, as disaggregated by type of delivery (vaginal vs cesarean) and opioid naivete.

Changes in legal referrals to specialty substance use disorder treatment from 2015-2019.

Background: The policy landscape around substance use has changed dramatically in the past decade, which may have affected the number and characteristics of treatment episodes for substance use disorder (SUD). In this study, we examine changes in the volume of SUD treatment referrals from the legal system and compare changes in the composition of substances used by referral source. We used publicly available discharge data on specialty SUD treatment episodes in the U.

Aging in isolation: Sexual orientation differences in navigating cognitive decline.

Introduction: Subjective cognitive decline is a self-reported measure of worsening memory and day-to-day decision making. Cognitive decline may impair an individual's ability to complete instrumental activities of daily living (IADL) such as preparing meals or taking medication, ultimately limiting one's ability to live independently. People with IADL impairments typically rely on informal care from spouses or children.

Equity Implications of the Affordable Care Act Among People With Past-Year Criminal Legal Interactions.

Objective: This study examined whether expansions of Affordable Care Act (ACA) coverage led to changes in insurance coverage and behavioral health treatment use among adults with past-year criminal legal interactions.

Methods: National Survey on Drug Use and Health data and a difference-in-differences design were used to compare changes in insurance coverage and behavioral health treatment use among respondents with a mental or substance use disorder, by past-year criminal legal involvement (N=103,818).

Results: Prior to ACA expansions, respondents with past-year criminal legal involvement (vs.

Use of residential opioid use disorder treatment among Medicaid enrollees in nine states.

Introduction: Residential treatment is a key component of the opioid use disorder care continuum, but research has not measured well the differences in its use across states at the enrollee level.

Methods: This cross-sectional observational study used Medicaid claims data from nine states to document the prevalence of residential treatment for opioid use disorder and to describe the characteristics of patients receiving care. For each patient characteristic, chi-square and t-tests tested for differences in the distribution between individuals who did and did not receive residential care.

Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states.

Background: Follow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes.

Difference-in-differences for categorical outcomes.

Objective: To discuss and develop difference-in-difference estimators for categorical outcomes and apply them to estimate the effect of the Affordable Care Act's Medicaid expansion on insurance coverage.

Data Sources: Secondary analysis of Survey on Income and Program Participation (SIPP) data on health insurance coverage types before (January 2013) and after (December 2015) Medicaid expansion in 39 US states (19 expansion and 20 non-expansion).

Study Design: We develop difference-in-difference methods for repeated measures (panel data) of categorical outcomes.

Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength.

Introduction: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment.

Methods: We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes.

Ensemble learning to predict opioid-related overdose using statewide prescription drug monitoring program and hospital discharge data in the state of Tennessee.

Objective: To develop and validate algorithms for predicting 30-day fatal and nonfatal opioid-related overdose using statewide data sources including prescription drug monitoring program data, Hospital Discharge Data System data, and Tennessee (TN) vital records. Current overdose prevention efforts in TN rely on descriptive and retrospective analyses without prognostication.

Materials And Methods: Study data included 3 041 668 TN patients with 71 479 191 controlled substance prescriptions from 2012 to 2017.

Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy.

Background: The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear.

Methods: The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen-negative HIV-positive adults initiating antiretroviral therapy with CD4 counts <50 cells/µL.

Birds of a feather flock together: Comparing controlled pre-post designs.

Objective: To formalize comparative interrupted time series (CITS) using the potential outcomes framework; compare two version of CITS-a standard linear version and one that adds postperiod group-by-time parameters-to two versions of difference-in-differences (DID)-a standard version with time fixed effects and one that adds group-specific pretrends; and reanalyze three previously published papers using these models.

Data Sources: Outcome data for reanalyses come from two counties' jail booking and release data, Medicaid prescription drug rebate data from the Centers for Medicare and Medicaid Services (CMS), and acute hepatitis C incidence from the Centers for Disease Control and Prevention.

Study Design: DID and CITS were compared using potential outcomes, and reanalyses were conducted using the four described pre-post study designs.

Medicaid Waivers and Access to Behavioral Health Services: What Is Known and What Can Be Expected.

In the past 5 years, Medicaid programs have implemented administrative barriers to enrollment. The impact of these provisions on access to mental health and substance use disorder treatment has been largely unstudied. This column reviews the literature on the previous changes to Medicaid enrollment and treatment use, current policy landscape, and steps that states or localities may take to offset these administrative burdens.

Problems with Evidence Assessment in COVID-19 Health Policy Impact Evaluation: A systematic review of study design and evidence strength.

Introduction: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature.

Medicaid Expansion's Spillover to the Criminal Justice System: Evidence from Six Urban Counties.

Spillovers from the Affordable Care Act Medicaid expansion to other social-sector outcomes have received little attention. One that may be especially salient for public policy is the impact of expanded eligibility on jail-related outcomes. This study compares recidivism outcomes in three non-expansion counties to nearby expansion counties before and after Medicaid expansion.

Development of a Tobacco Control Prescription in a Southern US City.

The Problem: Nationwide efforts to reduce smoking in the United States have been successful. Yet, there is unequal geographic progress in reducing rates of smoking and smoking-related illnesses. Located in a tobacco-producing state with weak tobacco laws, Nashville, Tennessee, has an adult smoking rate of 22.

The impact of expanded Medicaid eligibility on access to naloxone.

Background And Aims: Federal, state and local US governments have sought interventions to reduce deaths due to opioid overdoses by increasing the availability of naloxone. The Affordable Care Act (ACA) expanded Medicaid coverage to low-income, childless adults, potentially giving this group financial access to naloxone. The aims of this paper are: (1) to describe the changes in the amount of Medicaid-covered naloxone used between 2009 and 2016 and (2) to quantify the differential change in the amount of dispensed naloxone between states that expanded their Medicaid programs and states that did not.

State laws and policies to reduce opioid-related harm: A qualitative assessment of PDMPs and naloxone programs in ten U.S. States.

As the magnitude of the opioid epidemic grew in recent years, individual states across the United States of America enacted myriad policies to address its complications. We conducted a qualitative examination of the structure, successes, and challenges of enacted state laws and policies aimed at the opioid epidemic, with an in-depth focus on prescription drug monitoring programs (PDMPs) and naloxone access efforts. A set of 10 states (Florida, Kentucky, Massachusetts, Michigan, Missouri, New York, North Carolina, Tennessee, Washington, and West Virginia) was chosen a priori to achieve a varied sample of state policies and timing, as well as population opioid complications.

Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults With Depression.

Objective: Multiple studies have detailed the relationship between Medicaid expansion under the Affordable Care Act and various health and financial outcomes. However, fewer studies have examined Medicaid expansion's effects on individuals with psychiatric diagnoses. This study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression.

New Approaches In Medicaid: Work Requirements, Health Savings Accounts, And Health Care Access.

Alternative approaches in Medicaid are proliferating under the Trump administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and Medicaid expansion. Our sample consisted of 2,739 low-income nonelderly adults in three Midwestern states: Ohio, which expanded eligibility for traditional Medicaid; Indiana, which expanded Medicaid using health savings accounts called POWER accounts; and Kansas, which has not expanded Medicaid.