Abstract
OBJECTIVE: To identify state strategies to increase access to medications for opioid use disorder (MOUD) through Section 1115 Substance Use Disorder waivers. STUDY SETTING AND DESIGN: 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. DATA SOURCES AND ANALYTIC SAMPLE: After excluding five states due to insufficient information, we analyzed 22 applications. PRINCIPAL FINDINGS: 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 & 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. CONCLUSIONS: 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.