Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.

This study used Medicaid claims data to (1) describe the workforce that is caring for rural (including micropolitan adjacent, micropolitan non-adjacent and small and remote rural counties) versus urban populations with opioid use disorder (OUD) covered by Medicaid insurance, treatments received, (including medications (e.g. buprenorphine, naltrexone) and cognitive therapy) and retention in treatment (duration); (2) explore regional differences in care for urban and rural patients with Medicaid insurance; (3) compare care received by patients living in counties with and without a waivered clinician; (4) compare the distance and time that patients from micropolitan adjacent, micropolitan non-adjacent and small and remote rural counties travel for OUD care compared to urban patients; and (5) compare the cost of treatment for patients with OUD from rural and urban areas. Analyses will also compare nurse practitioner (NP) prescribing practices in states that require NP supervision by physicians with those that allow NPs to prescribe autonomously.

Findings from this study shed light on treatment disparities between rural and urban patients with OUD and between rural patients with commercial insurance compared to those with Medicaid insurance. This analysis provides a more complete picture of where and from whom rural patients with OUD receive care in the absence of a comprehensive OUD treatment workforce in their local communities. Study findings can inform Federal and state policies to ensure access to care among vulnerable, rural populations.

Publications

• Comparing the Care and Distance Traveled by Rural and Urban Medicaid Beneficiaries With Opioid Use Disorder
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 03/2026
  This Medicaid claims study describes the treatment for rural versus urban Medicaid beneficiaries with opioid use disorder (OUD). Rural Medicaid beneficiaries with OUD had fewer average health care visits (64.6 visits) and traveled more miles on average to access care (70.4 miles) than their urban counterparts (92.3 visits and 32.7 miles).
• Differences in the Travel Burden for Care Between Rural and Urban Patients With Opioid Use Disorder by Insurance Type
  Journal Article
  WWAMI Rural Health Research Center
  Date: 09/2025
  Using claims data, this article compares the distance and time that urban and rural Medicaid and commercially insured enrollees with opioid use disorder (OUD) travel to care. Rural Medicaid and commercially insured enrollees traveled farther and longer to access care.