Medicaid Participation Research Articles

Racial differences in distribution of number of prenatal visits: analysis of US natality data

Racial disparity in pregnancy outcomes is a major public health issue. We analyzed the distribution of the number of prenatal visits across races and ethnic groups to identify differences that may account for variations in pregnancy outcomes. In this study we used the 2016-2019 U.S. natality data provided by the CDC consisting of 15,340,627 births. The distribution of the number of prenatal visits of White, Black, Asian, and Hispanic patients were analyzed. A Z-test was performed to determine if the distribution differed from the White population. The effect of insurance/payment types was also considered. As shown in Table 1, there are significant differences in the insurance types among racial groups. Hispanic and Black populations had a higher number of Medicaid participation than the White population. Asian had significantly lower Medicaid enrollment. Self-pay percentage was higher in Hispanic and Asian races whereas only 2.2% of White and 3% of Black population were without insurance. Overall, the White population had more prenatal visits than other groups (p< 0.01) with the exception of the self-pay group where the Asian population had more prenatal visits. (p< 0.01). The Hispanic and Black populations had fewer prenatal visits regardless of the forms of insurance/payment, with Black race having the fewest number of prenatal visits. Compared to other groups, more White mothers had 11+ prenatal visits. Since an adequate number of prenatal visits in term patients is between 11-14, more White patients received an optimal number of prenatal visits in comparison to other groups. Our findings show that there is a racial difference in frequency of prenatal care, especially with fewer prenatal visits among the Black race. This trend exists regardless of insurance. Considering that the number of patients without insurance is low, the availability of insurance may not explain this phenomenon. Fewer visits in Black race is especially concerning as they have more adverse pregnancy outcomes. Resolving this disparity may improve pregnancy outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

UNDERSTANDING SPENDDOWN TO MEDICAID IN ASSISTED LIVING: SURVEY RESULTS FROM PARTICIPANTS/REPRESENTATIVES IN MINNESOTA

Abstract The state of Minnesota has seen substantial growth in the use of Medicaid in Assisted Living and wanted to better understand how applicants spend down to Medicaid in order to identify potential upstream interventions to prolong the spend down period. As part of a mixed methods research effort, 231 new Medicaid participants or their proxies, 167 in AL and 64 at home, completed a telephone survey on their services use prior to Medicaid application, prior planning or thinking of how to pay for services once personal resources were exhausted, and experience of spenddown once in AL. Reaching these eligible participants required a unique, multi-step outreach process; given the abilities of participants to respond, the majority of surveys were completed by proxies. Among those in AL, 40% reported planning in advance about how to pay for services once needed; 58% knew of government programs to assist and 80% reported their plan included applying to the programs at some time. Thirteen percent (13%) of those in AL reported getting help from the Medicaid waiver at the time of move in; another 25% said they paid for themselves for less than one year before getting state support. More than one-third (34%) who paid for their services for some period of time after move in said the period was shorter than expected; another 41% said about as expected, and for 25% the period was longer than expected. Open-ended comments indicate a move to memory care was a key factor in spend down to Medicaid.

Surgeon Perspective on Medicaid Participation for Mohs Micrographic Surgery: A Nationwide Survey of the Workforce.

Beltrami, Eric BS*; Hooper, Jette MD†; Kodumudi, Vijay MD*; Feng, Hao MD, MHS† Author Information

Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members Who Smoke

Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines' provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them. This secondary analysis examined the differences in the source and use of cessation treatment by insurance type and their impacts on cessation. The parent trial excluded people who were pregnant, had private insurance, or were not ready to quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income people who smoke daily completed a baseline survey and were enrolled in a quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were completed in August 2022. Participants were classified as Medicaid/dual (55%), Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the trial, owing to a system error, the quitline provided nicotine replacement therapy to all study participants regardless of insurance type. Before error versus after error, Medicaid participants reported lower nicotine replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds of quitting (7-day point prevalence) by 3 months increased for people who smoke who completed more quitline calls and used any (36% quit) versus used no (20% quit) pharmacotherapy, but quitting did not differ by insurance classifications (27%-29%). Getting and using nicotine replacement therapy from the quitline produced the highest quit rates (38%). Results illustrate the benefit of receiving nicotine replacement therapy from the quitline on cessation. Mailing nicotine replacement therapy to all people who smoke should be standard practice to reduce smoking disparities.

How do low-income single-mothers get by when unemployment strikes: Patterns of multiple program participation after transition from employment to unemployment.

Little is known about longitudinal patterns of welfare program participation among single mothers after they transition from employment to unemployment. To better understand how utilization patterns of these welfare programs may change during the 12 months after a job loss, we used the 2008 Survey of Income and Program Participation to examine the patterns of participation in Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and unemployment insurance among 342 single mothers who transitioned from employment to unemployment during the Great Recession. Using sequence analysis and cluster analysis, this paper identified four distinct patterns of program participation: (a) constantly receiving in-kind benefits; (b) primarily but not solely receiving food stamps; (c) inconsistent unemployment insurance or Medicaid-based benefits; and (d) limited or no benefits. Almost two-fifths of our sample of single mothers received inconsistent, limited, or no benefits. Results of the multinomial regression revealed that race, work disability, poverty, homeownership, and region of residence were significant factors that influenced whether study subjects participated in or had access to social safety net programs. Our findings illustrate the heterogeneity in patterns of multiple program participation among single mothers transitioning from employment to unemployment. Better understanding these varied patterns may inform decisions that increase the accessibility of US social safety net programs for single mothers during periods of personal economic hardship.

Limits of prenatal care coordination for improving birth outcomes among Medicaid participants

Maternity Care Homes (MCHs) intend to address clinical and psychosocial needs for perinatal patients and are commonly implemented for Medicaid beneficiaries. Rigorous evidence supporting MCHs' effectiveness for improving birth outcomes is thin, but most studies consider only clinical and demographic factors from administrative data. To assess birth outcomes with controls for psychosocial variables known to affect them, this paper considers quantitative participant-level data from the Strong Start for Mothers and Newborns prenatal care initiative, with qualitative case study data to further contextualize results. From 2013 to 2017, Strong Start served over 45,000 Medicaid beneficiaries in 32 states, D.C., and Puerto Rico though MCHs, group prenatal care, or freestanding birth centers. Participant data included risks screens for food insecurity, depression, anxiety, pregnancy intention, and intimate partner violence, in addition to clinical and demographic information. After clinical, demographic and psychosocial risks were controlled in a regression model, Strong Start birth center participants showed significantly lower rates of preterm birth, low birthweight, and cesarean section relative to MCH participants (p < .01). In group prenatal care, White participants showed lower rates of preterm birth (p < .01) and Black participants showed lower rates of low birthweight (p < .05) relative to MCH participants. Strong Start participants reported appreciation for MCH care managers' support, but community and clinical referrals often had long waiting lists or were inaccessible. Transformative care models focusing on provider continuity, relationship building, and patient activation may offer more promise for improving birth outcomes than supplementing medical models with care management and other resources.

Enrollment Brokers Did Not Increase Medicaid Enrollment, 2008–18

Between 2008 and 2018, six states and Washington, D.C., began contracting with enrollment brokers to facilitate enrollment into Medicaid, joining the eighteen states that already had such contracts in place as of 2008. Using newly collected data covering all contracts between state Medicaid agencies and independent enrollment brokers during this period, we compared changes in Medicaid participation following the initiation of contracts with enrollment brokers with contemporaneous changes in Medicaid participation in states that never contracted with brokers. We found that contract initiation had no statistically significant effects on state-level Medicaid participation. We further found no evidence of other enrollment-related benefits, such as improved application processing times.

Practice patterns of postgraduate trained dentists in the United States

Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists. Individual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD-trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC. Individual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign-trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high-poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC. Federal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.

Factors associated with Medicaid participation among infants born with birth defects in Texas, 2010-2014.

Birth defects are major contributors to healthcare resource use, disability, and mortality, particularly during the perinatal period. As the nation's public insurance program for low-income individuals, Medicaid funds a large proportion of healthcare costs associated with birth defects. Here, we explore birth defect-related factors associated with Medicaid participation in the first year of life. Infants born with birth defects between 2010 and 2014 were linked from the Texas Birth Defects Registry to the state's Medicaid claims database. Variation in Medicaid participation was examined by individual birth defect and by birth defect characteristics. The associations between covariates and Medicaid participation are described using percentages and adjusted prevalence ratios (APR). Of the 107,968 infants included in this study, 55,172 (51.1%) participated in Medicaid. Medicaid participation ranged from 12.1% for anencephaly to 77.8% for total anomalous pulmonary venous connection. An indicator of defect severity was associated with an increased likelihood of participation (APR=1.22, 95% CI: 1.20-1.23). Medicaid participation was 60.8% for individuals with multiple major defects, compared with 45.4% for those without (APR=1.24, 95% CI: 1.22-1.25). Among individual birth defects, Medicaid participation was almost universally higher for those co-occurring with other major defects. We detected large variations in Medicaid participation by individual birth defect. Infants participating in Medicaid tended to have more severe defects and were more likely to have multiple major defects. Medicaid claims databases can serve as valuable sources of data for surveillance efforts and observational studies, but care should be taken when generalizing findings.

Innovative Use of the Health Status Questionnaire-12 for Individual and Population Health.

Demonstrate how self-reported health (SRH) percentile ranks can be used in public health and clinical practice for better interpretable data. Secondary analysis was completed to standardize Health Status Questionnaire-12 Version 2.0 (HSQ-12) scores. The HSQ-12 is a multi-item measure of SRH, with a Total Health Status Scale (THSS) and two subscales, Physical Health Status Scale (PHSS) and Mental Health Status Scale (MHSS). The sample included adult (19 and older) participants in Medicaid, including a normed sample (n=7,110) and population cohorts of midlife women (n=417) and pregnant women (n=1,888). Normed percentile data for HSQ-12 using the Medicaid sample were calculated and populations of midlife and pregnant women were compared with the normed percentile ranks. Results illustrate differences in percentile rank scores for the various population cohorts. This innovative strategy has the potential to lead to decisions that may positively influence health policies, outcomes, and lower health costs.

Moving Back Into the Community: Obstacles for People With an Acquired Brain Injury or Physical Disability.

To investigate transitions from long-term institutional care to the community in people with an acquired brain injury (ABI) or a physical disability (PD). Secondary objectives were to identify barriers in each group. Retrospective observational study based on a person-centered plan and structured interviews to identify potential barriers. Long-term institutional care; 2954 Medicaid participants younger than 65 interested in community living. Analysis with SPSS 25 of 445 people with an ABI and 2509 with a PD living in long-term care between December 2008 and November 2017. The main outcome was transition to the community. Secondary measures identified specific barriers such as consumer engagement, gender, and age. Of the 2954 total cases, 1810 (61.3%) transitioned to the community; 57.5% of the ABI group (n= 256) and 61.9% of the PD group (n= 1554) transitioned. Although the PD group transitioned at a slightly higher rate, no significant association was found between the program (ABI or PD) and the likelihood of transitioning [χ2 (df= 1)= 3.096, P= .078]. Overall, in the ABI group, difficulties with the funding program, OR= 0.373 ± 0.238, and other individuals, OR= 0.396 ± 0.344, decreased the odds of transitioning more than other challenges, whereas lack of consumer engagement, OR= 0.659 ± 0.100, had the strongest influence on preventing transitions in the PD group. Living in the community improves quality of life and decreases costs. No previous studies have focused on the major obstacles for 2 specific groups, those with an ABI and those with a PD. Identifying transition rates and specific barriers for different groups is an important step to developing systems that will overcome these obstacles. In addition, the equivalent transition rates between these groups highlights the benefit of increased funding and range of services for those with complex needs and support requirements.

Dentists Who Participate in Medicaid: Who They Are, Where They Locate, How They Practice.

Low utilization of dental services among low-income individuals and racial minorities reflects pervasive inequities in U.S. health care. There is limited research determining common characteristics among dentists who participate in Medicaid or the Children's Health Insurance Program. Using detailed Medicaid claims data and a provider database, we estimate that among dentists with 100 or more pediatric Medicaid patients, 48% practice in high-poverty areas, 10% practice in rural areas, and 29% work in large practices (11 or more dentists). Among those with zero Medicaid patients, 18% practice in high-poverty areas, 4% practice in rural areas, and 11% work in large practices. We found that dentist race/ethnicity has an independent effect on Medicaid participation even when adjusting for community characteristics, meaning non-White dentists are more likely to treat Medicaid patients, regardless of the median income or racial/ethnic profile of the community.

Assessment of Dentist Participation in Public Insurance Programs for Children in the US

Evaluating the availability of dentists to provide dental care services to children is important for identifying interventions for improving access. To assess dental care availability for children in the US by public insurance participation, rural-urban setting, and dentist taxonomy (general, pediatric, or specialized). This cross-sectional study analyzed the availability of dentists from matching 3 data sets: the 2020 National Plan and Provider Enumeration System, the 2019-2020 State Board of Dentistry information acquired from each state, and the 2019 InsureKidsNow.org database. Data on active dentists in most states (including the District of Columbia [combined hereinafter with states] and excluding Hawaii and Washington) were included in the analysis. The study was conducted from January 2019 to March 2022. The number and percentage of dentists participating in public insurance programs (Medicaid and/or Children's Health Insurance Program [CHIP]) were aggregated at the dental office and stratified by the rurality of their practice and taxonomy. State-level comparisons were derived between this study and reports from the Health Policy Institute of the American Dental Association, along with maps and summary statistics disseminated through a data portal and state reports. Among 204 279 active dentists, participation in public insurance varied widely across states, especially for the states that manage the Medicaid and CHIP programs separately. Participation rates in Medicaid and CHIP varied substantially from those of the Health Policy Institute of the American Dental Association. Participation in Medicaid and CHIP was lowest among urban dentists (Medicaid, 26%; CHIP, 29%) and highest among rural dentists (Medicaid, 39%; CHIP, 40%), while urban dentists accounted for most of the dentist population (urban, 84%; rural, 5%). Similarly, participation in Medicaid and CHIP was substantially lower among general dentists (Medicaid, 28%; CHIP, 29%) vs pediatric dentists (57% in both programs), while each state's dentist population consisted of notably more general (84%) than pediatric (3%) dentists. Nearly half of the states revealed wide variations in Medicaid and CHIP participation between counties, ranging from no participation (21 states) to full participation (22 states). The findings of this study suggest that disparities in the availability of dentists for pediatric dental care are extensive, particularly for Medicaid- and CHIP-insured children, those living in rural communities, and those receiving specialized care. Lack of dentist availability for Medicaid- and CHIP-insured children appears to deter access to receiving dental care.

Examining Medicaid Participation and Medicaid Entry Among Senior Medicare Beneficiaries With Linked Administrative and Survey Data.

Because Medicare beneficiaries can qualify for Medicaid through several pathways, duals who newly enroll in Medicaid may have experienced various financial and/or health changes that impact their Medicaid eligibility. Alternatively, new enrollment could reflect changes in awareness of the program among those previously eligible. Using monthly enrollment data linked to Health and Retirement Study survey data, we examine financial and health changes that occur around the time new Medicaid participants enter the program, and we compare those with changes experienced by both those continuously enrolled in Medicaid and those not enrolled. We find that Medicaid entry is often timed with a marked increase in out-of-pocket medical expenses, a substantial decrease in assets for some, and increases in activities of daily living (ADL) limitations. We also observe financial changes among persons continuously enrolled in Medicaid. Our results inform discussions about Medicaid eligibility policies and potential gaps in the protection that Medicaid offers from financial risk.

Medication Nonuse and Hospital Utilization: Medicaid Participants With Type 2 Diabetes in New York City

This study assesses the proportion of New York City Medicaid participants diagnosed with type 2 diabetes who did not have any claims for diabetes medication for an entire year and the association between nonuse of diabetes medication and subsequent hospitalizations. The 2014‒2016 New York State Medicaid claims data were used for this cohort study. Two types of hospitalizations were examined: all-cause hospitalizations and preventable diabetes hospitalizations. A potential association between medication nonuse and the number of hospitalizations in the following year was assessed using the negative binomial regression model, adjusting for individual- and neighborhood-level factors. The study was conducted in 2019‒2020. Among the 117,183 individuals included in this study, 27.5% did not use any diabetes medication for an entire year. Compared with individuals using oral hypoglycemic medication only, the crude rate of all-cause hospitalizations among individuals who used no medication was approximately twice as high (37,111 vs 19,209 per 100,000 population), and the crude rate of preventable diabetes hospitalizations was almost 3 times as high (1,488 vs 537 per 100,000 population). Adjusting for individual- and neighborhood-level characteristics, medication nonuse was still associated with higher levels of all-cause hospitalizations (incidence rate ratio=1.26; 95% CI=1.21, 1.31) and preventable diabetes hospitalizations (incidence rate ratio=1.66; 95% CI=1.39, 1.99). Medication use and adherence are important for managing diabetes. However, almost 30% of New York City Medicaid participants with type 2 diabetes had no claims for diabetes medication for an entire year. Significantly higher hospitalization rates among this group warrant attention from providers and policy makers.

The effect of differential privacy on Medicaid participation among racial and ethnic minority groups.

To investigate how county and state-level estimates of Medicaid enrollment among the total, non-Hispanic White, non-Hispanic Black or African American, and Hispanic or Latino/a population are affected by Differential Privacy (DP), where statistical noise is added to the public decennial US census data to protect individual privacy. We obtained population counts from the final version of the US Census Bureau Differential Privacy Demonstration Products from 2010 and combined them with Medicaid enrollment data. We compared 2010 county and state-level population counts released under the traditional disclosure avoidance techniques and the ones produced with the proposed DP procedures. Not applicable. We find the DP method introduces errors up to 10% into counts and proportions of Medicaid participation rate accuracy at the county level, especially for small subpopulations and racial and ethnic minority groups. The effect of DP on Medicaid participation rate accuracy is only small and negligible at the state level. The implementation of DP in the 2020 census can affect the analyses of health disparities and health care access and use among different subpopulations in the United States. The planned implementation of DP in other census-related surveys such as the American Community Survey can misrepresent Medicaid participation rates for small racial and ethnic minority groups. This can affect Medicaid funding decisions.

Pathway to Hospice: How Has Place of Care before Hospice Changed with the Growth of Hospice in the United States?

Background: Hospice use among Medicare decedents increased from 21.6% in 2000 to 51.6% in 2019. Whether this growth has been accompanied by more referrals to hospice directly from the community is not known. Objective: To assess trends in place of care before hospice enrollment. Design: Retrospective cohort from 2011 to 2018. Subjects: Medicare decedents age ≥66 years. Measure: Location of care before hospice enrollment in the last 90 days of life, defined as: the community with and without home health, short- or long-term nursing facility, or inpatient hospital. A county-level random effects model examined changes in enrollment from the community after adjusting for admitting diagnosis, age, race/ethnicity, sex, and Medicaid participation. Results: Among hospice enrollees (N = 7,650,933), 27.7% transitioned to hospice from the community, 31.8% transitioned from the hospital, and 10.1% transitioned after short- or long-term nursing facility stay. Rates of enrollment to hospice from the community remained stable from 35.1% in 2011 to 34.3% in 2018. After adjustment, the proportion enrolling in hospice from the community decreased by 1.2% (95% confidence interval -1.0% to 1.4%). Place of care before hospice enrollment in 2018 varied by hospice admitting diagnosis, with patients with cancer more likely to enroll from the community (39.5%) and patients with cerebrovascular accidents from the hospital (53.2%). Prior place of care varied by state, with Florida having the highest rate of the enrollment following hospitalization (47.8%). Conclusion: Despite the growth of hospice, the site of care before hospice enrollment has remained relatively stable and was strongly influenced by region.

In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians.

States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that require plans to contract with a minimum number of physicians. In this study we used data from the period 2015-17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year. Care was highly concentrated: 25percent of primary care physicians provided 86percent of the care, and 25percent of specialists, on average, provided 75percent of the care. Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries' preferences and physicians' willingness to serve Medicaid patients.

Longitudinal assessment of Indiana dentists’ participation in Medicaid before and after expansion

BackgroundAlthough Medicaid expansion aims to eliminate financial barriers to health care for low-income people in the United States, health care accessibility cannot be guaranteed without clinicians who provide health care to Medicaid recipients. This study examined the characteristics of Indiana dentists that are associated with the likelihood of participating in Medicaid after expansion in 2015. MethodsThis study included Indiana-licensed dentists who renewed their licenses in 2018 and provided supplemental data elements related to demographics, education and training, and professional characteristics. Dentists’ Medicaid engagement behavior was categorized on the basis of when claims were submitted from 2014 through 2017. Statistical analyses included the χ2 test and generalized multinomial logit model. ResultsOverall, 2,037 Indiana-licensed dentists were included in the study. Of these, 802 (39.4%) were continually active in Medicaid during the study period, and 116 (5.7%) became active after expansion. Dentists had a greater likelihood of engaging in Medicaid after expansion if they were female, specialized in oral and maxillofacial surgery, practiced in a group practice, and were located in a rural county. ConclusionsThis study shows that dentists with certain demographic and practice characteristics had a greater likelihood of participation in Indiana Medicaid after expansion in 2015. Several findings from this study are consistent with previous research regarding the emerging trends in workforce diversity and show the impact of expansion policies on the dental safety net. Practical ImplicationsThis study presents an effective framework for the use of administrative and regulatory data sources for state-level analysis of the Medicaid safety net.

Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?

Medicaid is a public health insurance program in the United States that serves low-income individuals. Medicaid beneficiaries have elevated risk of opioid use disorder (OUD), yet face barriers to receiving medications for OUD (MOUD). To inform efforts to increase MOUD receipt among Medicaid beneficiaries, this study: (1) estimated Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and (2) estimated the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Retrospective study of North Carolina, USA licensed physicians, physician assistants and nurse practitioners. Licensure data from 2018 were merged with 2019 US Drug Enforcement Administration (DEA) data to identify clinicians who received the DEA waiver required to prescribe buprenorphine (n = 1714). Medicaid claims data were used to characterize clinician engagement in OUD care delivery. Outcomes were indicators of any Medicaid professional claims and any Medicaid prescription claims for buprenorphine and/or naltrexone. Predictors included clinician characteristics (e.g. gender and race) and characteristics of clinicians' practice location (e.g. area opioid overdose death rate). Most waivered clinicians delivered services to Medicaid beneficiaries, ranging from 67.0% of behavioral health clinicians to 82.9% of specialist physicians. Among waivered clinicians with Medicaid professional claims, prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians. The probability of prescribing MOUD to Medicaid beneficiaries was higher among waivered clinicians identifying as male compared with female (8.5 percentage points, P = 0.004) or black compared with white (9.9 percentage points, P = 0.007), older clinicians (0.5 percentage point increase per year, P < 0.001) and clinicians in counties with a higher opioid overdose death rate (5.0 percentage point increase per additional death per 10 000 residents, P = 0.010). Among clinicians in North Carolina, USA who are authorized to prescribe buprenorphine, 67-83% (depending on type of specialist) deliver services to Medicaid beneficiaries, but only 30-52% of those prescribe medications for opioid use disorder (OUD) to Medicaid beneficiaries. Engagement in OUD care delivery to Medicaid beneficiaries varies by clinician demographic and area characteristics.