About
The Data
This dashboard includes data on South Carolina Medicaid enrollees and uninsured individuals newly diagnosed with opioid use disorder in 2021-2025, who either received treatment through a County Alcohol and Drug Authority or Opioid Treatment Program, or were diagnosed in the emergency department.
Of the roughly two million nonelderly adults in America with opioid use disorder, about a fifth are uninsured and two fifths are on Medicaid.[i] These adults are particularly vulnerable because of limited access to treatment and care.
What is the Medicaid Program?
Medicaid is the United States’ health insurance program for low-income Americans. In South Carolina, Medicaid provides health coverage for children, pregnant women, women during the first year after the birth of their child, caretaker parents, elderly adults, and people with disabilities who meet income eligibility criteria. Over one million South Carolinians are enrolled in Medicaid each year—roughly one in three residents in the state.[ii] Medicaid coverage includes a broad array of psychosocial treatment services and all three forms of medications for opioid use disorder. It is important to understand the treatment experiences of South Carolina residents enrolled in Medicaid because they represent a very large proportion of the state’s population. Learn more about South Carolina Medicaid here.
Data and Study Population
South Carolina collects healthcare claims for all inpatient and outpatient medical services and prescriptions paid for by the Medicaid program. These data were made available under a data use agreement to researchers at the University of South Carolina after approval from the Office of Revenue and Fiscal Affairs, the Department of Health and Human Services, and the Department of Alcohol and Other Drug Abuse Services. Guided by the Opioid Cascade of Care framework, the research team used claims data for Medicaid enrollees between the ages of 18 and 64 and uninsured individuals aged 18-64 (defined by those who had at least a three-month continuous period with no evidence of any insurance coverage) who were seen by healthcare providers in a County Alcohol and Drug Authority or Opioid Treatment Program or the emergency department.
Cohorts included in this analysis are as follows:
- Medicaid cohort – SC Medicaid enrollees aged 18–64 with at least 10 months of enrollment in each year.
- 2021: 464,493 people
- 2022: 491,976 people
- 2023: 454,164 people
- 2024: 336,170 people
- 2025: 344,823 people*
- Uninsured cohort – uninsured adults aged 18–64 with a continuous 3-month period without insurance evidence, seen at a County Alcohol and Drug Authority, Opioid Treatment Program, or emergency department.
- 2021: 221,589 people
- 2022: 223,799 people
- 2023: 217,382 people
- 2024: 220,272 people
- 2025: 171,382 people*
*Note: 2025 cohort data is partial and only includes the first 6 months of 2025 rather than the full year. We defined a new diagnosis as an opioid use disorder diagnosis with a clean 2-month lookback window – that is, there were no opioid use disorder diagnoses or treatments in the prior two months for that patient. Because 2025 only includes 6 months total of data, this only allowed us to scan the 4.5 months following diagnosis for any treatment initiation. Following initiation, thee 3 months were left to scan for retention in that treatment. Data and percentages will be updated with the full year of data once available.
Several counties are collapsed into larger geographic catchment areas due to small numbers of patients at some stages of the Cascade: the Barnwell area includes Allendale, Bamberg, Barnwell, and Hampton counties; the Greenwood area includes Abbeville, Edgefield, Greenwood, McCormick, and Saluda counties; and the Newberry area includes Chester, Fairfield, and Newberry counties. Counts of 10 and under are suppressed in order to comply with data protection and confidentiality requirements.
This study was approved by the University of South Carolina’s Institutional Review Board.
Methods
Download methods in PDF format.
Dashboard Measures
Treatment cascade rates were estimated using measures adapted from measure specifications that have been validated using Medicaid and other health insurance claims data. The Centers for Disease Control and the National Institute for Drug Abuse have referenced the Opioid Cascade of Care and encouraged healthcare systems, counties, and states to use these measures as a guide for how to improve treatment for patients with opioid use disorder.
These measures are based in part on National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures, which are some of the most widely used insurance plan performance measures. HEDIS measures are validated, claims-based measures that give a standardized format to compare health system and plan performance across states and years. The NCQA and NQF provide guidelines for creation of these variables (for example, psychosocial and medication initiation within 14 and 34 days, and diagnosis in the first 10.5 months of the year) that help standardize measures across plans, states, and research teams.
Limitations of Data
Data is representative of only individuals using Medicaid as their health insurance or those who are uninsured and received care in a County Alcohol and Drug Authority or Opioid Treatment Program or emergency department. Data does not represent individuals who have private insurance or those who are uninsured and received treatment at a Federally Qualified Health Center (FQHC). Medicaid data might miss prescribed, unused, or non-reimbursed medical care or services, as it only captures care provided when a bill was submitted. Percentages displayed are estimates based on the data and do not reflect exact counts. State regions are based on the South Carolina Department of Public Health Regions. These data reflect trends in opioid use disorder diagnosis and treatment receipt during the COVID-19 pandemic, which may differ significantly from such trends during the non-pandemic period.
Inclusion Criteria
Adults aged 18-64 years old who were enrolled in Medicaid for at least 10 months of 2021-2025 or who had a three-month continuous period without any evidence of insurance coverage in 2021-2025 are included in this data. Individuals with only one record indicating lack of insurance were classified as uninsured for the full year if there was no evidence of insured status.