Table 1.

Characteristics of the Thirteen States Participating in the Medicaid Outcomes Distributed Research Network

	DE	KY	MA	MD	ME	MI	NC	OH	PA	TN	VA	WV	WI
Number of Medicaid Enrollees (Millions)¹ (10/ 2020)	0.234	1.515	1.793	1.353	0.318	2.663	2.336	2.973	3.097	1.660	1.576	0.561	1.327
Percent of Medicaid Enrollees in Risk-Based MCOs² (7/2019)	97.0%	91.0%	42.0%	85.7%	0%	76.5%	0.1%⁴	93.7%	89.3%	100%	98.0%	77.0%	78.3%
ACA Expansion	1/2014	1/2014	1/2014	1/2014	1/2019	4/2014	NA	1/2014	1/2015	NA	1/2019	1/2014	NA
Medicaid fee index³ (All Services, 2016)	1.40	0.98	1.12	1.35	0.85	0.90	1.05	0.85	0.93	NA	1.10	1.08	.80
Behavioral Health Carve-Out⁴ (7/2019)	Varies	No	No	Yes	NA	Yes	Yes⁵	No	Yes	No	Varies	No	No
Medication for OUD prior authorization (per state-specific Preferred Drug Lists)⁶	No, for B & N. Yes for M.	No, for B & N. Yes for M.	No	No, for B & N. Yes for M.	No, for N. Yes, for B & M	No, for B & N. Yes for M.	Yes	Yes, for B waived for some providers	Yes, for B. No for M & N.	Yes, for B & M. No for N.	Yes, for B waived in 2017 for some prov.	Yes, for M. No, for B & N.	No
IMD exclusion waiver⁷ (10/2019)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
1115(a) SUD waiver status, dates (10/2019)⁸	Yes, since 7/2019	Yes, since 1/2018	Yes, since 10/2014	Yes, since 7/2016	Yes, since 12/2020	Yes, since 4/2019	Yes, since 10/2018	Yes, since 9/2019	Yes, since 6/2018	Yes, since 2/2016	Yes, since 4/1/2017	Yes, since 10/2017	Yes, since 10/2018

Notes: ACA is Affordable Care Act; IMD is Institutions for Mental Diseases; OUD is opioid use disorder; MCO is managed care organization; SUD is substance use disorder

^1.

CMS https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/enrollment-mbes/index.html

^2.

CMS https://www.medicaid.gov/medicaid/managed-care/enrollment-report/index.html

^3.

Kaiser Family Foundation. https://www.kff.org/statedata/ Medicaid fee index measures each state’s physician fees relative to national average.

^4.

Some states ‘carve-out’ responsibility for managing behavioral health services from Medicaid managed care organization contracts and contract with separate behavioral health managed care organizations. Kaiser Family Foundation tracks state carve out decisions. https://files.kff.org/attachment/Tables-Report-A-View-from-the-States-Key-Medicaid-Policy-Changes

^5.

North Carolina implemented managed care for physical health services in July 2021 and for behavioral health services in July 2022.

^6.

B is buprenorphine, N is for injectable naltrexone, and M is for methadone. These medications approved to treat OUD are sometimes subject to utilization management controls such as requirements that prescribers obtain prior authorization prior to prescribing medications like buprenorphine.

^7.

The 1965 amendments to the Social Security Act that created Medicaid and Medicare included a Medicaid Institutions for Mental Diseases (IMD) exclusion which prohibits the use of federalMedicaid financing for care provided to adult patients in mental health and substance use disorder residential treatment facilities that are larger than 16 beds. States can pursue federal waivers from this exclusion and the status of those waivers is tracked by the Kaiser Family Foundation. State Options for Medicaid Coverage of Inpatient Behavioral Health Services – Appendices – 9368 | KFF and the National Conference of State Legislatures. Medicaid 1115 Waivers by State (ncsl.org)

^8.

Several states have taken advantage of opportunities under the authority of section 1115(a) of the Social Security Act (Act) to demonstrate and test flexibilities to improve the continuum of care for Medicaid beneficiaries with substance use disorders (SUDs) with approval from CMS. The table lists the dates when MODRN states received CMS approval to implement their 1115 SUD waiver programs which varied in scope by state.