Institute for Behavioral Health

Medicaid Managed Care Opioid and Alcohol Treatment Policy Study (MOATS)

The Medicaid Managed Care Opioid and Alcohol Treatment Policy Study (MOATS) examines the relationships between Medicaid managed care organization policies and access to and quality of substance use disorder (SUD) treatment services with the goal of identifying strategies to improve substance use treatment.

The United States continues to struggle with a major crisis of opioid addiction. More than 93,000 people deaths were attributed to opioid use in 2020. Rates of opioid use disorders (OUDs) in the Medicaid population are almost twice as high as the general population, thus ensuring access to quality OUD treatment is a necessity for Medicaid enrollees.

In addition, unhealthy alcohol use is common in the United States; 66 million Americans reported binge drinking in the last month and 14.6 million have an alcohol use disorder. Early data show alcohol use increased with COVID-19. Rates of alcohol-related health conditions are disproportionately high and increasing among racial/ethnic minorities and women. Almost 90,000 Americans die annually from alcohol use.  Further, alcohol-related deaths have been increasing at a faster rate for racial/ethnic minorities, women and in rural areas.

Almost all state Medicaid programs contract with Medicaid managed care organizations to deliver and manage health care services Medicaid managed care organizations serve over 54 million Americans -nearly 70% of Medicaid enrollees. Managed care organizations must adhere to state Medicaid requirements, but also have flexibility to implement their own policy decisions. Despite the reach of Medicaid managed care, there is limited information about policies that may affect SUD treatment access and quality. Building on the success of four previous commercial health plan surveys, this project will provide a current picture of SUD treatment services in Medicaid managed care plans.

Findings will provide valuable information regarding access to and effectiveness of SUD treatment in Medicaid managed care organizations. This information can be used by plan administrators as they develop and implement plan policies, state Medicaid directors as they contract with and regulate Medicaid managed care organizations and federal policy makers making determinations about use of Medicaid waivers and other efforts to address opioid and alcohol use disorders in the US, to help stem the tide of SUD its often-deadly consequences.


The Medicaid Managed Care Opioid and Alcohol Treatment Policy Study (MOATS) is funded by The National Institute on Drug Abuse (NIDA; Grant: R01DA049776) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA; Grant: R01AA029821). NIDA and NIAAA are Institutes within the National Institutes of Health. The contents of this website do not represent the policy of NIDA, NIAAA, or NIH, and do not signify endorsement by the United States Federal Government.

Deliverables from the previous Brandeis University Commercial Health Plan Study

 The 2014 Brandeis University Commercial Health Plan Study resulted in a summary respondent report; briefings for health plans, the Association for Behavioral Health and Wellness (ABHW), The National Committee on Quality Assurance (NCQA), and administrators in the Department of Health and Human Services; and publications in peer-reviewed journals. A selection of reports and manuscripts follows.

  1. Hodgkin D, Horgan CM, Stewart MT, Quinn AE, Creedon TB, Reif S, & Garnick DW. (2018). Federal parity and access to behavioral health care in private health plans. Psychiatric Services 2018; 69(4): 396-402 appi. ps. 201700203.
  2. Stewart MT, Horgan CM, Hodgkin D, et al. Behavioral health coverage under the Affordable Care Act: What can we learn from marketplace products? Psychiatric Services. 2017 69(3):315-321:appi. ps. 201700098.
  3. Quinn AE, Reif S, Merrick EL, Horgan CM, Garnick DW, Stewart MT. How do private health plans manage specialty behavioral health treatment entry and continuing care? Psychiatric Services 2017;68(9):931-937.
  4. Stewart MT, Horgan CM, Quinn AE, et al. The role of health plans in supporting behavioral health integration. Administration and Policy in Mental Health and Mental Health Services Research. 2017:1-11.
  5. Garnick, D. W., Horgan, C. M., Merrick, E. L., Hodgkin, D., Reif, S., Quinn, A. E., Stewart, MT., Creedon,T. B. (2017). Private health plans’ contracts with managed behavioral healthcare organizations. The Journal of Behavioral Health Services & Research, 44(1), 149-157.
  6. Reif S, Creedon TB, Horgan CM, Stewart MT, Garnick DW. Commercial health plan coverage of selected treatments for opioid use disorders from 2003 to 2014. Journal of Psychoactive Drugs. 2017:19.
  7. Quinn AE, Reif S, Evans B, Creedon T, Stewart MT, Garnick D, Horgan CM (2016). How health plans promote health IT to improve behavioral health care. American Journal of Managed Care 22 (12): 810-815.
  8. Reif S, Horgan CM, Hodgkin D, Matteucci A, Creedon TB, Stewart MT, Access to addiction pharmacotherapy in private health plans. Journal of Substance Abuse Treatment, (2016) 66: 23-29.
  9. Horgan CM, Hodgkin D, Stewart MT, Quinn AE, Merrick EL, Reif S, Garnick DW, Creedon TB. Health plan’ early response to federal parity legislation for mental health and addiction services. Psychiatric Services, (2016) 67(2):162-68.
  10. Horgan CM, Stewart MT, Reif S, Garnick DW, Hodgkin D, Merrick EL, Quinn AE. Behavioral health services in the changing landscape of private health plans. Psychiatric Services, (2016) 67(6): 622-9. PubMed Central PMCID: PMC4889503.
  11. Hodgkin D, Horgan CM, Creedon TB, Merrick EL, Stewart MT. Management of Newer Antidepressant Medications in U.S. Commercial Health Plans. J Ment Health Policy Econ. 2015 Dec;18(4):16573. PubMed PMID: 26729008; PubMed Central PMCID: PMC4812668.
  12. Hodgkin D, Horgan CM, Quinn AE, Merrick EL, Stewart MT, Leslie LK. Management of newer medications for attention-deficit/hyperactivity disorder in commercial health plans. Clin Ther. 2014 Dec 1; 36(12):2034-46. doi: 10.1016/j.clinthera.2014.09.019. Epub 2014 Nov 14.
  13. Horgan CM, Reif S, Stewart MT, Garnick DW, Hodgkin D, Quinn AE, Creedon T, Evans B. Substance Use Disorder and Mental Health Services in Health Plans: 2014 Focus on Parity and Health Reform. Preliminary Results from a Nationwide Study, Summary Report to Respondents. November 2015