Estimated Impact on Overdose Deaths and Costs of Medicaid Changes in the One Big Beautiful Bill Act

An estimated 12 million people may lose Medicaid coverage in the next decade as a result of Medicaid eligibility and spending restrictions legislated through the One Big Beautiful Bill Act (OBBBA). Researchers and state policy makers are concerned about individuals with substance use disorder as Medicaid covers 2 in 5 people with opioid use disorder (OUD) and provides access to life-saving and affordable medications for OUD. The new Medicaid work requirements exempt individuals with OUD, but the processes for verifying ongoing Medicaid eligibility or work exemption are not clearly defined and put this population at risk for coverage loss and OUD treatment disruptions.

Led by Avik Chatterjee, this pilot study will utilize simulation modeling to guide policy planning and implementation of the OBBBA-related eligibility changes to Medicaid. Dr. Chatterjee will develop the Coverage Estimation model to estimate the loss of healthcare coverage among people who have OUD under the OBBBA work requirements and adapt the Researching Effective Strategies to Prevent Overdose Deaths (RESPOND) model to predict changes in coverage for medications for OUD, overdose deaths, and costs to the healthcare sector under OBBBA.

Avik Chatterjee is a medicine- and pediatrics-trained primary care and addiction medicine physician at several shelter-based clinics through the Boston Health Care for the Homeless Program. At the same time, he is an associate professor of medicine at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center. His clinical and research interests include innovative treatment models for opioid use disorder in resource-limited populations, and interventions on social determinants of health, such as food insecurity. Dr. Chatterjee holds a Master of Public Health from Harvard T.H. Chan School of Public Health and completed his clinical residency at Yale-New Haven Hospital and general internal medicine fellowship at Harvard Medical School.