Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance

Abstract

BackgroundMedicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs’ acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites.MethodsWe analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments.ResultsMexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637).ConclusionsFindings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.

Workforce Diversity and disparities in wait time and retention among opioid treatment programs

“…Programs with both a higher percentage of Latino staff and a higher percentage of Latino clients stayed in treatment fewer days than programs with both a lower percent of Latino staff and clients. Consistent with other studies, these findings on the negative association between workforce diversity and measures of treatment engagement suggest that there may be other factors that explain these differences in access and retention [ 19 , 47 , 48 ]. Previous analyses of the NDATSS determined that treatment units with high client diversity tend to have lower retention rates as well as fewer engagement approaches to improve retention [ 49 – 51 ].…”

“…Culturally and linguistically Appropriate Services (CLAS) have been associated with SUD treatment access and engagement [ 2 , 10 , 13 ]. These CLAS generally include offering translated material, bilingual/bicultural counselors, space and services for families, while responsive policies include accessible service hours, flexible service delivery approaches, accepting Medicaid [ 2 , 10 , 19 ].…”

“…Developing understanding of the role of the Medicaid expansion on wait time and retention is critical in many ways. The main motivation of Medicaid expansion was to enhance access to care [ 13 ], hence it is important to examine how expected increases in public funding is associated with client treatment access and retention [ 18 , 19 ]. Medicaid expansion also increases regulation on quality of care, that includes provision of culturally responsive and evidence-based SUD treatment [ 20 ].…”

Using machine learning to advance disparities research: Subgroup analyses of access to opioid treatment

“…Improving access to OUD treatment, particularly for underserved groups, can reduce overdoses and opioid-related deaths. 3 African Americans face more barriers to accessing OUD treatment than non-Hispanic Whites, hereafter referred to as Whites, [4][5][6][7][8][9] and wait longer to enter substance use disorder treatment. 10 Previous research has established racial and ethnic disparities in access to treatment.…”

Management Practices to Enhance the Effectiveness of Substance Use Disorder Treatment

“…Management practices that rely on policy changes or practices, such as the ACA, can significantly improve access to care for under-represented population groups, including Hispanics and African-Americans, who remain more likely to be uninsured than Whites. Medicaid expansion and program acceptance of Medicaid reduces barriers to access treatment for racial and ethnic minority groups [34]. This is because SUD treatment programs are motivated to admit individuals to treatment to the extent that they have insurance coverage.…”