{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:09:58Z","timestamp":1789837798594,"version":"4.0.1"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>After the Medicaid continuous enrollment provision ended on March 31, 2023, millions of Medicaid patients were disenrolled, a process called \u201cMedicaid unwinding.\u201d Whether this process was associated with changes in dispensing of buprenorphine, a medication for opioid use disorder preventing opioid overdose deaths, is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate changes in buprenorphine dispensing during Medicaid unwinding.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study used difference-in-differences analysis to assess data from the IQVIA Longitudinal Prescription Database, capturing 92% of US retail prescriptions. Treatment and comparison states were those in the top vs bottom quartile of the percentage change in adult Medicaid enrollment between the month before the state resumed Medicaid eligibility determinations and December 31, 2023. Analyses included Medicaid-insured adults with active buprenorphine prescriptions in quarter 1 from 2017 to 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>State-level change in adult Medicaid enrollment. The preexposure period was from July 1, 2017, to December 31, 2022, and the postexposure period was from July 1 to December 31, 2023 (quarters 3 and 4).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Four outcomes assessed buprenorphine dispensing in quarters 3 and 4 from 2017 to 2023: the number of days with active buprenorphine prescriptions, no active prescriptions, 1 or more active prescriptions paid with private insurance, and 1 or more active cash-pay prescriptions. Linear and logistic regression models compared changes in outcomes over time among treatment and comparison states.<\/jats:p><\/jats:sec>Results<\/jats:title>Analyses included 754\u202f675 person-years from 569\u202f069 patients (mean [SD] age, 39.2 [9.6] years; 386\u202f719 men [51.2%]). Among adults in treatment states, the number of days with active buprenorphine prescriptions in quarters 3 and 4 decreased by 3.9 days (95% CI, \u22126.7 to \u22121.1 days) more compared with adults in comparison states. Adults in treatment states also had an increase of 1.8 percentage points (95% CI, 0.6-3.0 percentage points) in the probability of having no days with active prescriptions, an increase of 1.9 percentage points (95% CI, 0.4-3.4 percentage points) in the probability of having 1 or more active prescriptions paid with private insurance, and an increase of 0.9 percentage points (95% CI, 0.1-1.7 percentage points) in the probability of having 1 or more active cash-pay prescriptions.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study using difference-in-differences analysis, Medicaid patients in states with the highest vs lowest magnitude of Medicaid disenrollment through December 2023 were more likely to decrease or discontinue buprenorphine use and more likely to transition to private insurance or cash to pay for prescriptions. Findings suggest that Medicaid unwinding was associated with disruptions in buprenorphine therapy, raising concerns about the potential for increased opioid-related morbidity and mortality among patients in this population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8469","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T15:30:39Z","timestamp":1746199839000},"page":"e258469","source":"Crossref","is-referenced-by-count":16,"title":["Medicaid Unwinding and Changes in Buprenorphine Dispensing"],"prefix":"10.1001","volume":"8","author":[{"given":"Joanne","family":"Constantin","sequence":"first","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve M.","family":"Kenney","sequence":"additional","affiliation":[{"name":"Health Policy Center, Urban Institute, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosali","family":"Simon","sequence":"additional","affiliation":[{"name":"Paul H. O\u2019Neill School of Public and Environmental Affairs, Indiana University, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kao-Ping","family":"Chua","sequence":"additional","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"},{"name":"Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"zoi250309r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103715","article-title":"A mixed methods study of provider factors in buprenorphine treatment retention.","volume":"105","author":"Gertner","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"5","key":"zoi250309r21","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1176\/appi.ajp.20230808","article-title":"Defining discontinuation for buprenorphine treatment: implications for quality measurement.","volume":"181","author":"Williams","year":"2024","journal-title":"Am J Psychiatry"},{"issue":"5","key":"zoi250309r24","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1370\/afm.573","article-title":"Short-term impacts of coverage loss in a Medicaid population: early results from a prospective cohort study of the Oregon Health Plan.","volume":"4","author":"Carlson","year":"2006","journal-title":"Ann Fam Med"},{"issue":"8","key":"zoi250309r27","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1097\/MLR.0000000000001150","article-title":"Insurance loss in the era of the Affordable Care Act: association with access to health services.","volume":"57","author":"Mojtabai","year":"2019","journal-title":"Med Care"},{"issue":"6","key":"zoi250309r28","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1001\/jamainternmed.2023.0512","article-title":"Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.","volume":"183","author":"Roberts","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi250309r29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11606-008-0792-9","article-title":"Loss of health insurance among non-elderly adults in Medicaid.","volume":"24","author":"Sommers","year":"2009","journal-title":"J Gen Intern Med"},{"issue":"16","key":"zoi250309r30","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1056\/NEJMc2312906","article-title":"Buprenorphine dispensing after elimination of the waiver requirement.","volume":"390","author":"Chua","year":"2024","journal-title":"N Engl J Med"},{"issue":"16","key":"zoi250309r31","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1001\/jama.2023.1207","article-title":"Trends in buprenorphine initiation and retention in the United States, 2016-2022.","volume":"329","author":"Chua","year":"2023","journal-title":"JAMA"},{"key":"zoi250309r33","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.jsat.2014.12.011","article-title":"Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes.","volume":"52","author":"Bentzley","year":"2015","journal-title":"J Subst Abuse Treat"},{"issue":"6","key":"zoi250309r35","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.2193","article-title":"Coverage and access changes during Medicaid unwinding.","volume":"5","author":"McIntyre","year":"2024","journal-title":"JAMA Health Forum"},{"issue":"12","key":"zoi250309r37","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1007\/s11606-024-08819-2","article-title":"Association between cost-sharing and buprenorphine prescription abandonment.","volume":"39","author":"Chua","year":"2024","journal-title":"J Gen Intern Med"},{"key":"zoi250309r39","doi-asserted-by":"publisher","DOI":"10.1177\/29767342241303583","article-title":"Examining the impact of eliminating the X waiver on buprenorphine dispensation in 63 counties in Pennsylvania.","volume":"15","author":"Bilden","year":"2024","journal-title":"Subst Use Addctn J"},{"key":"zoi250309r19","volume-title":"Stata Statistical Software: Release 18","author":"StataCorp","year":"2023"},{"key":"zoi250309r1","unstructured":"10 Things to know about the unwinding of the Medicaid continuous enrollment provision. KFF. June 9, 2023. Accessed May 1, 2024. https:\/\/www.kff.org\/medicaid\/issue-brief\/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision"},{"key":"zoi250309r2","unstructured":"Nearly a quarter of people who say they were disenrolled from Medicaid during the unwinding are now uninsured: over half who were disenrolled say they put off needed medical care while trying to renew Medicaid. KFF. April 12, 2024. Accessed April 22, 2024. https:\/\/www.kff.org\/medicaid\/press-release\/nearly-a-quarter-of-people-who-say-they-were-disenrolled-from-medicaid-during-the-unwinding-are-now-uninsured\/"},{"key":"zoi250309r3","unstructured":"Karpman? M, Haley? JM, Long? J, Blavin? F, Kenney? GM. Changes in health care cost barriers with Medicaid continuous coverage and enhanced premium tax credits. Urban Institute. July 1, 2024. 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Updated April 28, 2023. Accessed July 27, 2024. https:\/\/www.cbpp.org\/research\/health\/unwinding-the-medicaid-continuous-coverage-requirement"},{"key":"zoi250309r7","unstructured":"Corallo? B, Moreno? S. Analysis of national trends in Medicaid and CHIP enrollment during the COVID-19 pandemic. KFF. April 4, 2023. Accessed July 10, 2024. https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment\/"},{"key":"zoi250309r8","unstructured":"Medicaid: federal oversight of state eligibility redeterminations should reflect lessons learned after COVID-19. U.S. Government Accountability Office. Accessed July 10, 2024. https:\/\/www.gao.gov\/assets\/gao-24-106883.pdf"},{"key":"zoi250309r9","unstructured":"Medicaid enrollment and unwinding tracker. KFF. Updated May 10, 2024. Accessed July 27, 2024. https:\/\/www.kff.org\/report-section\/medicaid-enrollment-and-unwinding-tracker-overview\/"},{"key":"zoi250309r10","unstructured":"Olsen? E. States\u2019 varying approaches complicate effort to determine impact of Medicaid redeterminations. Healthcare Dive. July 13, 2023. Accessed July 27, 2024. https:\/\/www.healthcaredive.com\/news\/medicaid-redeterminations-state-impact-vulnerable-lose-coverage\/686026\/"},{"key":"zoi250309r11","unstructured":"Buettgens? M, Carter? J, Banthin? J, Levitis? J. State variation in Medicaid and CHIP unwinding for children and adults as of November 2023. Robert Wood Johnson Foundation. May 2, 2024. Accessed May 2, 2024. https:\/\/www.rwjf.org\/en\/insights\/our-research\/2024\/05\/state-variation-in-medicaid-and-chip-unwinding-for-children-and-adults.html"},{"key":"zoi250309r12","unstructured":"Pifer? R. Medicaid redeterminations losses exceeding predicted levels in some states. Healthcare Dive. May 6, 2024. Accessed May 6, 2024. https:\/\/www.healthcaredive.com\/news\/medicaid-redeterminations-exceeding-projections-urban-rwjf\/715155\/?utm_medium=email&utm_source=rasa_io&utm_campaign=newsletter"},{"key":"zoi250309r13","doi-asserted-by":"crossref","unstructured":"Leshner? AI, Mancher? M, eds. Medications for Opioid Use Disorder Save Lives. The National Academies Press; 2019. Accessed April 22, 2024. https:\/\/nap.nationalacademies.org\/catalog\/25310\/medications-for-opioid-use-disorder-save-lives","DOI":"10.17226\/25310"},{"key":"zoi250309r14","unstructured":"Prescription information. IQVIA. Accessed May 5, 2024. https:\/\/www.iqvia.com\/locations\/united-states\/solutions\/life-sciences\/information-solutions\/essential-information\/prescription-information"},{"key":"zoi250309r15","unstructured":"Georgetown CCF state Medicaid\/CHIP enrollment data. Accessed May 5, 2024. https:\/\/docs.google.com\/spreadsheets\/d\/1iQsKRFYxpfj8PwQ22CFN9aDKjSzZE6PcxnUKKR3cGc4\/htmlview#gid=0"},{"key":"zoi250309r16","unstructured":"What is the impact of unwinding on Medicaid enrollment? Georgetown University McCourt School of Public Policy; Center for Children and Families. Accessed May 4, 2024. https:\/\/ccf.georgetown.edu\/unwinding-enrollment-data\/"},{"key":"zoi250309r17","unstructured":"Enhancing the QUAlity and Transparency Of health Research. EQUATOR Network. Accessed September 4, 2024. https:\/\/www.equator-network.org\/"},{"key":"zoi250309r18","unstructured":"Status of state Medicaid expansion decisions: interactive map. KFF. Updated May 8, 2024. 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