Medicaid is responding to the opioid crisis by covering treatment, innovating in the delivery of care, and working with other state agencies to reduce misuse of prescription opioids. However, there are gaps in the continuum of care, and states vary in the extent to which they cover needed treatment. An insufficient supply of providers also limits access to treatment in many locations. The delivery systems for physical health and behavioral health (which encompasses mental illness and substance use disorders) are traditionally separately organized and financed; the resulting fragmentation and lack of coordination can impede access to care and lead to inappropriate and insufficient use of services, poor health status, and increased costs. . . .

Medicaid beneficiaries with opioid use disorder are more likely to receive treatment than privately insured adults with the disorder, both inpatient and outpatient treatment. They are about three times more likely to receive drug or alcohol treatment in a hospital as an inpatient or in a residential treatment facility than privately insured adults, and they are almost twice as likely to receive care on an outpatient basis from a mental health center than privately insured adults. Treatment services, however, remain substantially underutilized; this is often referred to as the treatment gap.