Medicaid Unwinding: Association with New and Ending Buprenorphine Treatment Episodes

Medicaid Unwinding: Association with New and Ending Buprenorphine Treatment Episodes

Published: September/October 2025
Journal Article

Overview

This one-hour, on-demand, journal article-based activity examines how Medicaid unwinding (the resumption of normal Medicaid eligibility checks) affected buprenorphine treatment for opioid use disorder (OUD). This study assesses changes in both new and ending treatment episodes following Medicaid disenrollment.

The target audience for this intermediate continuing education activity includes: physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers.

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice  

Abstract

Aims 

Medicaid is an important source of coverage for buprenorphine treatment for opioid use disorder (OUD). The loss of Medicaid coverage through Medicaid unwinding may substantially impact individuals’ ability to initiate and continue buprenorphine, but little is known about how Medicaid unwinding is associated with buprenorphine OUD treatment. Objective: Examine the association of Medicaid unwinding overall and by magnitude of unwinding with changes in buprenorphine OUD treatment.

Methods

Retrospective cohort study using 2021-2023 national retail pharmacy data on dispensed buprenorphine prescriptions. Exposure: Magnitude of Medicaid disenrollment in the 6 months after unwinding began. Main outcome(s) and Measure(s): Average monthly change in new and ending buprenorphine treatment episodes, defined as starting buprenorphine treatment after 30 days without buprenorphine and ending after 30 days without buprenorphine. Statistical significance was assessed using 95% CI constructed from 2-sample t tests.

Results

Medicaid unwinding was associated with increases in Medicaid buprenorphine episodes ending (+3.0%, 95% CI: –1.1, 7.0, n = +5350) and decreases in new Medicaid episodes (–2.6%, 95% CI: –5.3, 0.1, n = –5756). The greatest changes were in states with the greatest disenrollment (+5.5%, 95% CI: 0.8, 10.1; n = +2320 for episodes ending and –3.9%, 95% CI: –7.3, –0.6; n = –1843 for episodes starting). Changes in Medicaid-covered episodes were not offset by other payers: among all payers, we observed an increase in episodes ending (+2.7%, 95% CI: 1.9, 3.4, n = +10,300) and a negligible increase in new episodes (+0.1%, 95% CI: –0.7, 1.0, n = +570).

Conclusion

Medicaid unwinding may have resulted in substantial disruptions to buprenorphine treatment.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Summarize the study design and methods used to evaluate the impact of Medicaid unwinding on buprenorphine treatment for OUD. 
2. Interpret the findings regarding changes in new and ending buprenorphine treatment episodes following Medicaid disenrollment. 
3. Identify the potential clinical and policy implications of Medicaid coverage disruptions for patients receiving buprenorphine treatment. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

Membership Question?  Call ASAM at 1.301.656.3920, email us, or view the ASAM website for more information.

Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to education@asam.org within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 10/01/2025 - 02/03/2028

Close Access Date: 02/03/2028

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. Participants will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered

  

  American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Addiction Medicine (ABAM)
• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-0227.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures