Abstract
Problems accessing affordable treatment are common among low-income adults with substance use disorders. A difference-in-differences analysis was performed to assess changes in insurance and treatment of low-income adults with common substance use disorders following the 2014 ACA Medicaid expansion, using data from the 2008–2017 National Surveys on Drug Use and Health. Lack of insurance among low-income adults with substance use disorders in expansion states declined from 34.8% (2012–2013) to 20.0% (2014–2015) to 13.5% (2016–2017) while Medicaid coverage increased from 24.8% (2012–2013) to 48.0% (2016–2017). In nonexpansion states, lack of insurance declined from 44.8% (2012–2013) to 34.2% (2016–2017) and Medicaid coverage increased from 14.3% (2012–2013) to 23.4% (2016–2017). Treatment rates remained low and little changed. Medicaid expansion contributed to insurance coverage gains for low-income adults with substance use disorders, although persistent treatment gaps underscore clinical and policy challenges of engaging these newly insured adults in treatment.
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References
Olfson M, Blanco C, Wall M, et al. Treatment of common mental disorders in the United States. Journal of Clinical Psychiatry 2019;80(3):18m12532.
Lipari RN, Van Horn SL. Trends in substance use disorders among adults aged 18 or older. The CBHSQ Report: June 29, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
Ali MM, Teich JL, Mutter R. Reasons for not seeking substance use disorder treatment: variations by health insurance coverage. Journal of Behavioral Health Services & Research. 2017;44(1):63-74.
Center for Behavioral Health Statistics and Quality (CBHSQ). 2015. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. HHS Publication No. SMA 15-4927, NSDUH Series H-50. Rockville, MD.
Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) waves 1 and 2: review and summary of findings. Social Psychiatry and Psychiatric Epidemiology. 2015;50:1609-1640.
Garfield RL. Mental health financing in the United States: a primer. Kaiser Commission on Medicaid and the Uninsured, April 2011.
Kaiser Common Medicaid and the Uninsured, Five key questions and answers about section 1115 Medicaid demonstration waivers. June 2011. https://www.kff.org/wp-content/uploads/2013/01/8196.pdf Accessed on August 10, 2020.
Tormohlen KN, Krawczyk N, Feder KA, et al. Evaluating the role of Section 1115 waivers on Medicaid coverage and utilization of opioid agonist therapy among substance use treatment admissions. Health Services Research. 2019 Dec 29;55(2):232-8.
Sommers BD, Arnston E, Kenney GM, Epstein AM. Lessons from early Medicaid expansions under health reform interviews with Medicaid officials. Medicare & Medicaid Research Review 2013;3(4): E1-E19.
Olfson M, Wall M, Barry CL, et al. Impact of Medicaid expansion on coverage and treatment of low-income adults with substance use disorders. Health Affairs 2018;37(8):1208-1215.
Mojtabai R, Mauro C, Wall M, et al. The Affordable Care Act and opioid agonist therapy for opioid use disorder. Psychiatric Services 2019; 70 (7):617-620.
Mojtabai R, Mauro C, Barry C, et al. Medication treatment for opioid use disorders in substance use treatment facilities in the United States. Health Affairs 2019;38:14-23.
Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health [Internet]. Rockville (MD): SAMHSA; Available from: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-useand-health Accessed on August 10, 2020.
National Academies of Sciences, Engineering, and Medicine. 2019. Medications for opioid use disorder save lives. Washington, DC: The National Academies Press. https://doi.org/10.17226/25310 Accessed on August 10, 2020.
Wild TC. Social control and coercion in addiction treatment: towards evidence-based policy and practice. Addiction 2006;101(1):40-49.
Buck JA. The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Affairs 2011; 1402-1410
Department of Health and Human Services, fiscal year 2021 justification of estimates for appropriations committees, Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/sites/default/files/about_us/budget/fy-2021-samhsa-cj.pdf Accessed on August 10, 2020.
Department of Health and Human Services, fiscal year 2016 justification of estimates for appropriations committees, Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/sites/default/files/samhsa-fy2016-congressional-justification_2.pdf Accessed on August 10, 2020.
Cummings JR, Wen H, Ko M, Druss BG. Race/ethnicity and geographic access to Medicaid substance use disorder treatment facilities in the United States. JAMA Psychiatry 2014;71(2):190-196.
Andrews CM, Grogan CM, Westlake MA, Abraham AJ, et al., Do benefits restrictions limit Medicaid acceptance in addition treatment? Results from a national study. Journal of Substance Abuse Treatment 2018;87:50-55.
Wen H, Hockenberry JM, Borders TF, Druss BG. Impact of Medicaid expansion on Medicaid-covered utilization of buprenorphine for opioid use disorder treatment. Medical Care 2017;55:336-341.
Meinhofer A, Witman AE. The role of health insurance on treatment for opioid use disorders: evidence from the Affordable Care Act Medicaid expansion. Journal of Health Economics 2018;60:177-197.
Maclean LC, Saloner B. The effect of public insurance expansions on substance use disorder treatment: evidence from the Affordable Care Act. Journal of Policy Analysis and Management 2019;38(2):366-393.
Mojtabai R, Feder KA, Kealhofer M, et al. State variations in Medicaid enrollment and utilization of substance use services: results from a national longitudinal study. Journal of Substance Abuse Treatment 2018; 89:75-86.
Wen H, Hockenberry JM, Pollack HA. Association of buprenorphine-waivered physician supply with buprenorphine treatment use and prescription opioid use in Medicaid enrollees. JAMA Network Open 2018;1(5):e182943.
Barocas JA, White LF, Wang J, et al., Estimated prevalence of opioid use disorder in Massachusetts, 2011–2015: a capture–recapture analysis. American Journal of Public Health 2018;108:1675-1681.
Andrews CM. The relationship of state Medicaid coverage to Medicaid acceptance among substance abuse providers in the United States. Journal of Behavioral Health Services & Research 2014;41(4): 460-472.
Andrews C, Abraham A, Grogan CM, et al., Despite resources from the ACA, most states do little to help addiction treatment programs implement health care reform. Health Affairs 2015;34(5):828-835.
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This work is supported by NIDA R01 DA039137.
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Olfson, M., Wall, M., Barry, C.L. et al. Medicaid Expansion and Low-Income Adults with Substance Use Disorders. J Behav Health Serv Res 48, 477–486 (2021). https://doi.org/10.1007/s11414-020-09738-w
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DOI: https://doi.org/10.1007/s11414-020-09738-w