{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:37:30Z","timestamp":1772987850928,"version":"3.50.1"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify state strategies to increase access to medications for opioid use disorder (MOUD) through Section\u00a01115 Substance Use Disorder waivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We conducted a qualitative analysis of 27 waiver applications that were implemented between 2015 and 2020. We identified barriers and proposed strategies for expanding MOUD access and utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>After excluding five states due to insufficient information, we analyzed 22 applications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>We identified six barriers and eight corresponding strategies. Barriers included care delays, limited MOUD facilities, lack of care transition support, limited MOUD access in residential treatment, insufficient care coordination, and prescriber shortages. Commonly proposed strategies were requiring access to MOUD in residential treatment, which was stipulated by the Centers for Medicare &amp; Medicaid Services, addressing prescriber shortages through education and technical assistance, campaigns to address stigma, and increased reimbursement. Other strategies included changes to prior authorization requirements, efforts to increase the number of facilities that offer MOUD, and changes to improve care transitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>States proposed a variety of strategies to expand access to and use of MOUD. Future research could investigate how these approaches, implemented individually or in combination, are associated with outcome change and impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70061","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T09:35:16Z","timestamp":1761903316000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["State Proposed Strategies to Expand Access to Medications for Opioid Use Disorder"],"prefix":"10.1111","volume":"61","author":[{"given":"Andrea","family":"Baron","sequence":"first","affiliation":[{"name":"Department of Family Medicine Oregon Health &amp; Science University Portland Oregon USA"},{"name":"Boulder Care Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9356-6761","authenticated-orcid":false,"given":"Jennifer D.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Oregon Health &amp; Science University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Byers","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Oregon Health &amp; Science University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-6287","authenticated-orcid":false,"given":"Stephan","family":"Lindner","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University, Center for Health Systems Effectiveness Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Oregon Health &amp; Science University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"F.Ahmad J.Cisewski L.Rossen andP.Sutton \u201cProvisional Drug Overdose Death Counts \u201daccessed June 20 2025 https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug\u2010overdose\u2010data.htm."},{"key":"e_1_2_10_3_1","unstructured":"Substance Abuse and Mental Health Services Administration (SAMSHA) \u201cMedication\u2010Assisted Treatment (MAT) \u201daccessed August 22 2022 https:\/\/www.samhsa.gov\/medication\u2010assisted\u2010treatment."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-018-0094-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2007.02090.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.27488"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1595"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.280377"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.evalprogplan.2011.02.004"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12454"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.202000565"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2021.1936051"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.05.027"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.2147"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.02.018"},{"key":"e_1_2_10_16_1","unstructured":"W. L.White \u201cLong\u2010Term Strategies to Reduce the Stigma Attached to Addiction Treatment and Recovery Within the City of Philadelphia (With Particular Reference to Medication\u2010Assisted Treatment\/Recovery) \u201daccessed August 22 2022 https:\/\/dbhids.org\/wp\u2010content\/uploads\/2015\/07\/2009\u2010Philadelphia\u2010Papers\u2010Long\u2010Term\u2010Strategies\u2010to\u2010Reduce\u2010the\u2010Stigma\u2010Attached\u2010to\u2010Addiction.pdf."},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.9059"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2017.12.022"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.8969"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.4001"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae024"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1515\/jom\u20102021\u20100163"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16\u20102149"},{"key":"e_1_2_10_24_1","unstructured":"J.Atterman M.Dormond J.Schreiber et\u00a0al. \u201cBehavioral Health Workforce Implementation Challenges Related to Medication Assisted Treatment \u201daccessed August 29 2022 https:\/\/www.healthworkforceta.org\/wp\u2010content\/uploads\/2023\/08\/BHWRC_Implementation\u2010Challenges\u2010Related\u2010to\u2010MAT.pdf."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12289"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010019\u201004943\u20106"},{"key":"e_1_2_10_27_1","unstructured":"Medicaid and CHIP Payment and Access Commission \u201cSection\u00a01115 Waivers for Substance Use Disorder Treatment \u201daccessed July 7 2025 https:\/\/www.macpac.gov\/subtopic\/section\u20101115\u2010waivers\u2010for\u2010substance\u2010use\u2010disorder\u2010treatment\/."},{"key":"e_1_2_10_28_1","unstructured":"Medicaid and CHIP Payment and Access Commission \u201cPayment for Services in Institutions for Mental Diseases (IMDs) \u201daccessed October 22 2024 https:\/\/www.macpac.gov\/subtopic\/payment\u2010for\u2010services\u2010in\u2010institutions\u2010for\u2010mental\u2010diseases\u2010imds\/."},{"key":"e_1_2_10_29_1","unstructured":"Medicaid.Gov \u201cSubstance Use Disorder Section\u00a01115 Demonstration Opportunity \u201daccessed August 20 2024 https:\/\/www.medicaid.gov\/substance\u2010use\u2010disorder\u2010section\u20101115\u2010demonstration\u2010opportunity\/index.html."},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmab158"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203793206"},{"key":"e_1_2_10_33_1","volume-title":"Building a Better Delivery System: A New Engineering\/Health Care Partnership. National Academies Press (US)","author":"National Academy of Engineering (US) and Institute of Medicine (US) Committee on Engineering and the Health Care System","year":"2005"},{"key":"e_1_2_10_34_1","volume-title":"Qualitative Data Analysis: An Expanded Sourcebook","author":"Miles M. B.","year":"1994"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01023"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.00461"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00288"},{"key":"e_1_2_10_38_1","doi-asserted-by":"crossref","unstructured":"M. F.GarnettandA. M.Mini\u00f1o \u201cDrug Overdose Deaths in the United States 2003\u20132023 \u201d2024 https:\/\/doi.org\/10.15620\/cdc\/170565.","DOI":"10.15620\/cdc\/170565"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.70028"},{"key":"e_1_2_10_40_1","unstructured":"H.SaundersandN.Panchal \u201cAddressing the Opioid Crisis: A Look at the Evolving Landscape of Federal OUD Treatment Policies \u201daccessed July 2 2025 Kaiser Family Foundation https:\/\/www.kff.org\/mental\u2010health\/issue\u2010brief\/addressing\u2010the\u2010opioid\u2010crisis\u2010a\u2010look\u2010at\u2010the\u2010evolving\u2010landscape\u2010of\u2010federal\u2010oud\u2010treatment\u2010policies\/."},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/29767342241303583"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2312906"},{"key":"e_1_2_10_43_1","unstructured":"E.Hinton A.Diana andR.Rudowitz \u201cMedicaid Waiver Priorities Under the Trump and Biden\u2010Harris Administrations \u201daccessed June 19 2025 Kaiser Family Foundation https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/medicaid\u2010waiver\u2010priorities\u2010under\u2010the\u2010trump\u2010and\u2010biden\u2010harris\u2010administrations\/."},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245920"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2019.10.004"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70061","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70061","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:08:49Z","timestamp":1772968129000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":44,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/1475-6773.70061"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70061","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"assertion":[{"value":"2025-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70061"}}