Patients relying only on public health insurance are far less likely to receive addiction treatment services than those with more robust or multiple insurance types, according to a new Rutgers University study.
Researchers from the Rutgers School of Social Work analyzed medical records and discovered that people with opioid use disorder who were covered only by Medicaid or Medicare were much less likely to receive behavioral health care compared to patients with additional sources of funding.
“What’s most striking is how insurance type fundamentally shapes patient treatment,” said Jamey Lister, lead author and associate professor at the Rutgers School of Social Work. “We found that those using only public insurance often fall through the cracks.”
The study, published in the journal Addiction Science & Clinical Practice, comes at a time when public health insurance programs in the U.S. are facing potential budget cuts. The findings suggest these cuts could further limit access to treatment for those most in need.
Study Details and Key Findings
The research team examined the medical records of 705 patients diagnosed with opioid use disorder between 2015 and 2021. The data came from a community health center in Elizabeth, New Jersey, during a period that included the state’s Medicaid expansion under the Affordable Care Act.
Co-occurring conditions:
Around 72% of patients also had another substance use disorder, such as alcohol, cocaine, or cannabis use. Nearly 40% had a mental health condition as well.
Demographics:
About 40% of the patients were Black or African American, and over 70% were male.
Insurance coverage:
Patients were divided into groups based on insurance type, including Medicaid, Medicare, charity care, and private or other public sources.
When analyzing how often patients used therapy services like individual or group psychotherapy, the researchers found that those with Medicaid or Medicare and additional public coverage—such as court-mandated treatment—attended over twice as many sessions as those with only Medicaid or Medicare.
Policy Implications and Cost Concerns
Lister warned that cutting public insurance programs could worsen treatment gaps. Even after the Medicaid expansion, many barriers remain.
“We should be delivering care based on what patients need, not what their insurance can pay for,” said Lister. “Yet the system is doing the opposite.”
The researchers also pointed out the financial consequences. A 2021 American Medical Association study found that increasing access to opioid treatment can save between $25,000 and $105,000 per person over a lifetime. In contrast, the cost of overdoses and related criminal justice expenses continues to rise.
Team-Based Research for Better Solutions
One positive aspect of the study was its research method. The Rutgers team used a “team science” approach, which brought together professionals from social work, psychology, clinical care, and data science. This allowed them to create a more detailed picture of patients than what is usually possible with national databases.
“Clinics collect data for insurance and reimbursement,” Lister explained. “But through collaboration, we can turn that data into insights that help improve treatment strategies across the country.”
The research was conducted in partnership with Trinitas Regional Medical Center, part of RWJBarnabas Health, and supported by the U.S. Department of Health and Human Services’ Health Resources and Services Administration.
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