Access to Care in Florida for Pregnant Women with Opioid Use Disorder

Full Description: Opioid drug use within the United States has overwhelmingly increased throughout the last few decades. Pregnant women with a history of trauma, psychiatric illnesses, and substance abuse are at higher risk for opioid use disorder (OUD) and subsequent adverse maternal and birth outcomes, including neonatal abstinence, low birth weight, sudden infant death syndrome, and other adverse effects. Medication-assisted treatment (MAT) includes Methadone and Buprenorphine and is used as treatment care for pregnant women with OUD to improve birth outcomes. However, barriers to treatment and prenatal care remain prevalent. The secret shopper method, whereby callers anonymously call providers as patient actors to try and obtain an appointment, was used to identify the process and limitations that pregnant women on Medicaid experience to access MAT in Florida.

Over half of the providers were unreachable, and only 39% of those providers reached were able to make an appointment. Of providers reached, 17.1% did not take any form of Medicaid, 29.5% did not take Medicaid or the Medicaid HMO pre-verified by the caller, and 47% of the clinics accepted Methadone, while 21% did not. Challenges encountered by callers include difficulty reaching providers after five attempts, being placed on hold for over fifteen minutes,

multiple callbacks to and from providers, and judgemental or disrespectful tone from receptionists. Additionally, providers required identifying information upfront, including Medicaid insurance card numbers, documentation of confirmation of pregnancy, social security number, the name of their MAT provider, email, and home address.

The most common reasons for not being able to secure an appointment included: providers not accepting patients on methadone/MAT; providers not accepting any new Medicaid patients; not being able to progress in the appointment system without more information; being too far along in pregnancy by first available appointment; the receptionist not knowing if the insurance type is accepted or if patients in MAT were accepted; requirement of referral to the clinic, pre-consultation with doctor or pregnancy confirmation.
In efforts to shape the future of MAT treatment for pregnant women, this study shows that it is important to have an accurate list of Medicaid providers that is easily accessible to parents. Additionally, increasing the number of prenatal care providers who accept patients on MAT is crucial to expanding accessibility to prenatal care for this vulnerable population. Increased education on OUD and MAT for healthcare providers and receptionists who speak to patients is critical to increasing empathy and reducing stigma to ultimately improve the quality of prenatal care and advance health equity. Prioritizing patient education will also help shape a better future for pregnant parents on MAT.

Abbreviated Description: A secret shopper project was developed to measure and understand the barriers and access to treatment for Opioid Use Disorder (OUD) in Florida, access to prenatal care for parents undergoing Medicated Assisted Treatment (MAT) for OUD, and establish a community advisory group to advise researchers on all stages of the project. This analysis examines access to prenatal care for women on Medicaid receiving MAT in Florida by managed care organization. It also assessed wait time, reasons for denial, and tone of the clerk. Challenges in obtaining appointments include providers not accepting Medicaid patients, requiring identifying information such as social security number, being too far along with the pregnancy, and providers not taking Methadone patients.