All levels of US government have sought to reduce opioid overdose deaths, in part, by increasing the availability of naloxone. When the Affordable Care Act (ACA) expanded Medicaid coverage, lower-income adults, who have relatively higher rates of substance use disorder, were given improved financial access to naloxone in states that expanded Medicaid.

In a study published in Addiction, Margaret T. Morris Professor of Health Economics Richard G. Frank, PhD, and doctoral candidate in Health Policy and Statistics Carrie Fry looked at the changes in the amount of Medicaid-covered naloxone dispensed in states that expanded their Medicaid programs versus states that did not.

Since 2014, 36 states and the District of Columbia have expanded eligibility for their Medicaid programs to include all adults with incomes under 138% of the federal poverty line. Post-expansion, expansion states averaged more than 215 Medicaid-covered naloxone prescriptions per 100,000 Medicaid enrollees, while non-expansion states averaged 83  per 100,000 Medicaid enrollees.

Prior to Medicaid expansion, the amount of naloxone covered by Medicaid was similar in expansion and non-expansion states. States that chose to expand Medicaid coverage saw more than a four-fold increase in naloxone prescriptions per year compared to states that did not expand their Medicaid coverage. States that expanded Medicaid coverage also implemented factors such as standing orders for the dispensing of naloxone, allowing pharmacists to dispense naloxone without a prescription, and prescribing to third parties at higher rates than states that did not expand. This further increased access to naloxone in these states.

By providing increased financial access to naloxone, Medicaid expansion saves an estimated 22.7 lives per state per year. This study highlights Medicaid expansion’s importance in fighting the opioid epidemic, and it is likely to continue to be a tool for states in the future..