Screening, treatment, and referral for substance use disorder in Medicaid health homes: Results of a national pilot study

Introduction: Established under the Affordable Care Act, Medicaid health homes are designed to provide comprehensive health care for enrollees with chronic health conditions. Given high rates of substance use disorder (SUD) in Medicaid, health homes have the potential to enhance SUD identification and treatment. Yet little is known about the extent to which they engage in these activities. In this study, we assessed the proportion of health homes that screen, treat, and refer for SUD; health homes compliance with state plan requirements for SUD screening and treatment; and the extent to which these trends differ among health homes focusing on physical versus mental health and SUD. Methods: We administered a pilot survey in 2022 to all health care providers participating in active Medicaid health home models. Health home models were categorized as physical-, mental health-, or SUD-focused. We estimated the percentage of health homes engaged in SUD screening, treatment, and referral, and the percentage of health homes that complied with state requirements in each domain. Results: Our sample included 113 Medicaid health homes in 15 states and the District of Columbia. Physical health-focused health homes were more likely to screen for SUD than mental health-focused and SUD-focused health homes (81.0 % versus 63.4 % and 55.0 % respectively). Most health homes referred out at least some SUD treatment (84.1 %). Among those that did refer, fewer than 20 % had a formal contractual agreement with an SUD treatment program. The majority of health homes complied with state requirements for referral. However, among health homes required by their state to offer SUD screening, 38.5 % of physical health-, 10.0 % of mental health-, and 25.0 % of SUD-focused health homes failed to do so. Similarly, 5.9 % of physical health-, 67.9 % of mental health- and 45.0 % of SUD-focused health homes did not offer onsite SUD treatment, even when required to do so. Conclusions: While Medicaid health home plans were established to promote care coordination and integration, relatively few health homes in this study reported doing so in the case of SUD. A concerning number of health homes did not comply with state plan requirements for SUD screening and treatment.