{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:48:52Z","timestamp":1791884932443,"version":"4.3.4"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01AA029097"],"award-info":[{"award-number":["R01AA029097"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01AA029821"],"award-info":[{"award-number":["R01AA029821"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010232","name":"National Institute of Development Administration","doi-asserted-by":"publisher","award":["R01DA49776"],"award-info":[{"award-number":["R01DA49776"]}],"id":[{"id":"10.13039\/501100010232","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010232","name":"National Institute of Development Administration","doi-asserted-by":"publisher","award":["R01DA052425"],"award-info":[{"award-number":["R01DA052425"]}],"id":[{"id":"10.13039\/501100010232","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010232","name":"National Institute of Development Administration","doi-asserted-by":"publisher","award":["P30DA035772"],"award-info":[{"award-number":["P30DA035772"]}],"id":[{"id":"10.13039\/501100010232","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>States contract with Medicaid managed care plans to administer benefits for roughly 70 million Medicaid enrollees, yet little is known about how plan benefit policies for substance use disorder (SUD) treatment medications align with state requirements.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>In this study, we found that among the population of 167 Medicaid managed care plans responsible for SUD pharmacy benefits in 2021, many did not align with state requirements to cover SUD treatment medications.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Many plans imposed prior authorization requirements on these medications, even when prohibited from doing so. Alignment between state requirements and reported plan policies was less common among plans operating in Republican\u2010leaning states.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Medicaid is the largest payer of substance use disorder (SUD) treatment in the United States. Managed care plays an important role, administering benefits for more than 80% of Medicaid enrollees. While state governments have enacted coverage requirements for SUD treatment medications that managed care plans must follow, the extent to which managed care coverage policies align with these rules remains largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We linked a national survey of state Medicaid officials regarding state requirements for SUD medication benefits in 2021 with data on SUD medication coverage and management from all 167 Medicaid managed care plans in 2021. We assessed the extent to which plans aligned with state requirements\u2014overall, and by the dominant voter political lean in the state in which the plans were embedded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>In 2021, the proportion of Medicaid managed care plans aligned with state coverage requirements for alcohol use disorder treatment medications was slightly higher than that for opioid use disorder treatment medications. Alignment for coverage was more common than alignment with prior authorization prohibitions. Democratic\u2010leaning states were more likely to require coverage of alcohol and opioid use disorder medications, except in the case of methadone. In Republican\u2010leaning states, most managed care plans did not align with requirements to cover disulfiram and acamprosate and 45.4% did not align with methadone coverage requirements. Plans in Republican\u2010leaning states were less likely to align with prior authorization bans on every SUD treatment medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medicaid managed care plans located in Republican\u2010leaning states were less likely to be subject to state requirements governing coverage and prior authorization of SUD treatment medications, with the exception of methadone, and were also less likely to align with requirements when imposed by states.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70083","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T08:38:39Z","timestamp":1777279119000},"page":"508-533","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2020-4866","authenticated-orcid":false,"given":"SAGE R.","family":"FELTUS","sequence":"first","affiliation":[{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHRISTINA M.","family":"ANDREWS","sequence":"additional","affiliation":[{"name":"University of South Carolina Arnold School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LAUREN","family":"PETERSON","sequence":"additional","affiliation":[{"name":"The University of Chicago Crown Family School of Social Work, Policy, and Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"COLLEEN M.","family":"GROGAN","sequence":"additional","affiliation":[{"name":"The University of Chicago Crown Family School of Social Work, Policy, and Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7455-7464","authenticated-orcid":false,"given":"AMANDA J.","family":"ABRAHAM","sequence":"additional","affiliation":[{"name":"University of Georgia, School of Public and International Affairs"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OLIVIA M.","family":"HINDS","sequence":"additional","affiliation":[{"name":"University of South Carolina Arnold School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MAUREEN T.","family":"STEWART","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health"},{"name":"The Heller School for Social Policy and Management, Brandeis University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7308a1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc\/170565"},{"key":"e_1_2_7_4_1","unstructured":"National Institute on Alcohol Abuse and Alcoholism.Alcohol\u2010related emergencies and deaths in the United States. Published November 2024. Accessed March 26 2025.https:\/\/www.niaaa.nih.gov\/alcohols\u2010effects\u2010health\/alcohol\u2010topics\u2010z\/alcohol\u2010facts\u2010and\u2010statistics\/alcohol\u2010related\u2010emergencies\u2010and\u2010deaths\u2010united\u2010states"},{"key":"e_1_2_7_5_1","unstructured":"Substance Abuse and Mental Health Services Administration.Highlights for the 2023 National Survey on Drug Use and Health. Published online 2023. Accessed March 26 2025.https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/NSDUH%202023%20Annual%20Release\/2023\u2010nsduh\u2010main\u2010highlights.pdf"},{"key":"e_1_2_7_6_1","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics.U.S. overdose deaths decrease in 2023 first time since 2018. NCHS Press Release. Published May 14 2024. Accessed March 26 2025.https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2024\/20240515.htm"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3387"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2021.01.013"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.19761"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2023.01.037"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109498"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20622"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.17226\/25310"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.35946\/arcr.v41.1.07"},{"key":"e_1_2_7_15_1","unstructured":"National Institute on Alcohol Abuse and Alcoholism.Recommend evidence\u2010based treatment: know the options.The Healthcare Professional's Core Resource on Alcohol.2024. Accessed July 25 2024.https:\/\/www.niaaa.nih.gov\/health\u2010professionals\u2010communities\/core\u2010resource\u2010on\u2010alcohol\/recommend\u2010evidence\u2010based\u2010treatment\u2010know\u2010options"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.11406"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.13014"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3628"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360\u20100443.2012.04054.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2017.1750101"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000222512.25649.08"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20103107"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1550"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.4365"},{"key":"e_1_2_7_25_1","unstructured":"SaundersH.A look at substance use disorders (SUD) among Medicaid enrollees. KFF. Published February 17 2023. Accessed January 22 2024.https:\/\/www.kff.org\/mental\u2010health\/issue\u2010brief\/a\u2010look\u2010at\u2010substance\u2010use\u2010disorders\u2010sud\u2010among\u2010medicaid\u2010enrollees\/"},{"key":"e_1_2_7_26_1","unstructured":"HintonE RaphaelJ.10 things to know about Medicaid managed care. KFF. Published February 24 2023. Accessed February 27 2023.https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/10\u2010things\u2010to\u2010know\u2010about\u2010medicaid\u2010managed\u2010care\/"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2023.2171107"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01023"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1532440014561644"},{"key":"e_1_2_7_30_1","unstructured":"Kettering Family Foundation.The public's views on potential changes to Medicaid. KFF. Published March 7 2025. Accessed October 22 2025.https:\/\/www.kff.org\/medicaid\/kff\u2010health\u2010tracking\u2010poll\u2010public\u2010views\u2010on\u2010potential\u2010changes\u2010to\u2010medicaid\/"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1215\/03616878\u20108004886"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.0695"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00288"},{"key":"e_1_2_7_34_1","volume-title":"MACStats: Medicaid and CHIP Data Book","author":"MACPAC","year":"2021"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14394"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2025.112742"},{"key":"e_1_2_7_37_1","unstructured":"RaphaelJ HintonE.A look at Medicaid enrollment and finances of the five largest Medicaid managed care plans. KFF. Published February 4 2025. Accessed February 26 2025.https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/a\u2010look\u2010at\u2010medicaid\u2010enrollment\u2010and\u2010finances\u2010of\u2010the\u2010five\u2010largest\u2010medicaid\u2010managed\u2010care\u2010plans\/"},{"key":"e_1_2_7_38_1","unstructured":"WarshawC TausanovitchC.Subnational ideology and presidential vote estimates (V2022). Published online November 1 2022.https:\/\/doi.org\/10.7910\/DVN\/BQKU4M"},{"key":"e_1_2_7_39_1","unstructured":"Massachusetts Institute of Technology.MIT Election Data and Science Lab. Accessed January 28 2026.https:\/\/electionlab.mit.edu\/"},{"key":"e_1_2_7_40_1","unstructured":"Internal Revenue Service.Tax exempt organization search.2024. Accessed January 28 2025.https:\/\/www.irs.gov\/charities\u2010non\u2010profits\/tax\u2010exempt\u2010organization\u2010search"},{"key":"e_1_2_7_41_1","unstructured":"Substance Abuse and Mental Health Services Administration.Providers Clinical Support System\u2013Medications for Alcohol Use Disorders (PCSS\u2010MAUD). Last updated February 13 2024. Accessed June 6 2024.https:\/\/www.samhsa.gov\/medications\u2010alcohol\u2010use\u2010disorders\u2010pcss\u2010maud"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2017.07.001"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.1052"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2024.100233"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103492"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.9041"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106756"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/29767342241278871"},{"key":"e_1_2_7_49_1","unstructured":"SaundersH RudowitzR.A look at the latest alcohol death data and change over the last decade. KFF. Published May 23 2024. Accessed June 20 2024.https:\/\/www.kff.org\/mental\u2010health\/issue\u2010brief\/a\u2010look\u2010at\u2010the\u2010latest\u2010alcohol\u2010death\u2010data\u2010and\u2010change\u2010over\u2010the\u2010last\u2010decade\/"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.1757"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3132"}],"container-title":["The Milbank Quarterly"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1468-0009.70083","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1468-0009.70083","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1468-0009.70083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:30:30Z","timestamp":1791883830000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1468-0009.70083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":50,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/1468-0009.70083"],"URL":"https:\/\/doi.org\/10.1111\/1468-0009.70083","archive":["Portico"],"relation":{},"ISSN":["0887-378X","1468-0009"],"issn-type":[{"value":"0887-378X","type":"print"},{"value":"1468-0009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"2026-04-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}