This study uses 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 will 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 will provide 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.