Medicaid Expansion and Low-Income Adults with Substance Use Disorders

Olfson, Mark; Wall, Melanie M.; Barry, Colleen L.; Mauro, Christine; Feng, Tianshu; Mojtabai, Ramin

doi:10.1007/s11414-020-09738-w

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Our findings concerning the association between Expansion and health insurance coverage among PWID living in poverty are consistent with, and build upon, prior studies [22–25]. Our findings add important depth to this body of work by focusing upon PWID, and by identifying an effect size for insurance coverage that surpasses that in prior studies.…”

Section: Discussionsupporting

confidence: 89%

“…Parallel research on the effects of Medicaid expansion ('Expansion') on key outcomes among people who use drugs-but do not necessarily inject them-is still emerging. Several studies have found that Medicaid expansion has led to significant gains in Medicaid coverage and reductions in the percentage who are uninsured among those who use drugs [22][23][24][25]. An analysis of National Survey on Drug Use and Health (NSUDH) data, for example, found that Medicaid coverage was 14 percentage points higher pre-versus post-Expansion among impoverished people with heroin use disorder [23].…”

Section: Medicaid Expansion Is a Pillar Of The Patient Protection Andmentioning

confidence: 99%

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Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states

Cooper,

Beane,

Yarbrough

et al. 2023

Addiction

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Background and AimsImpoverished people who inject drugs (PWID) are at the epicenter of US drug‐related epidemics. Medicaid expansion is designed to reduce cost‐related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line.DesignA two‐way fixed‐effects model was used to analyze serial cross‐sectional observational data.SettingSeventeen metro areas in 13 US states took part in the study.ParticipantsParticipants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention’s National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD.MeasurementsState‐level Medicaid expansion was measured using Kaiser Family Foundation data. Individual‐level self‐report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation).FindingsThe sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two‐thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage‐point increase in the probability of insurance coverage, and a 9.0 (95% CI = −15.0, −0.2) percentage‐point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584).ConclusionsUS Medicaid expansion may curb drug‐related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non‐financial barriers may undermine expansion’s impact upon substance use disorder treatment in this sample.

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Section: Discussionsupporting

confidence: 89%

Section: Medicaid Expansion Is a Pillar Of The Patient Protection Andmentioning

confidence: 99%

Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states

Cooper,

Beane,

Yarbrough

et al. 2023

Addiction

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“…The use of benchmark multiplier method partly addresses these limitations by capitalizing on service utilization data covered by Medicaid rather than participation in surveys. Medicaid is the major payer for SUD services in the US, especially among marginalized populations . The benchmark multiplier method is especially useful for capturing these population groups that are not well represented in surveys .…”

Section: Discussionmentioning

confidence: 58%

Estimating the Prevalence of Substance Use Disorders in the US Using the Benchmark Multiplier Method

Mojtabai

2022

JAMA Psychiatry

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ImportancePrevalence estimates of substance use disorders in the US rely on general population surveys. However, major population groups, such as homeless individuals and institutionalized individuals, are not captured by these surveys, and participants may underreport substance use.ObjectiveTo estimate the prevalence of substance use disorders in the US.Design, Setting, and ParticipantsThe benchmark multiplier method was used to estimate the prevalence of alcohol, cannabis, opioid, and stimulant use disorders based on data from the Transformed Medicaid Statistical Information System (T-MSIS) (the benchmark) and the National Survey on Drug Use and Health (NSDUH) (the multiplier) for 2018 and 2019. T-MSIS collects administrative data on Medicaid beneficiaries 12 years and older with full or comprehensive benefits. NSDUH is a nationally representative annual cross-sectional survey of people 12 years and older. Data were analyzed from February to June 2022.Main Outcomes and MeasuresPrevalence of substance use disorders was estimated using the benchmark multiplier method based on T-MSIS and NSDUH data. Confidence intervals for the multiplier method estimates were computed using Monte Carlo simulations. Sensitivity of prevalence estimates to variations in multiplier values was assessed.ResultsThis study included Medicaid beneficiaries 12 years and older accessing treatment services in the past year with diagnoses of alcohol (n = 1 017 308 in 2018; n = 1 041 357 in 2019), cannabis (n = 643 737; n = 644 780), opioid (n = 1 406 455; n = 1 575 219), and stimulant (n = 610 858; n = 657 305) use disorders and NSDUH participants with 12-month DSM-IV alcohol (n = 3390 in 2018; n = 3363 in 2019), cannabis (n = 1426; n = 1604), opioid (n = 448; n = 369), and stimulant (n = 545; n = 559) use disorders. The benchmark multiplier prevalence estimates were higher than NSDUH estimates for every type of substance use disorder in both years and in the combined 2018 to 2019 sample: 20.27% (95% CI, 17.04-24.71) vs 5.34% (95% CI, 5.10-5.58), respectively, for alcohol; 7.57% (95% CI, 5.96-9.93) vs 1.68% (95% CI, 1.59-1.79) for cannabis; 3.46% (95% CI, 2.97-4.12) vs 0.68% (0.60-0.78) for opioid; and 1.91% (95% CI, 1.63-2.30) vs 0.85% (95% CI, 0.75-0.96) for stimulant use disorders. In sensitivity analyses, the differences between the benchmark multiplier method and NSDUH estimates persisted over a wide range of potential multiplier values.Conclusions and RelevanceThe findings in this study reflect a higher national prevalence of substance use disorders than that represented by NSDUH estimates, suggesting a greater burden of these conditions in the US.

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“…Medicaid covers substance use disorder patients, except for the 10 states, where Medicaid expansion covers low-income patients. 27 However, more frequent coverage of OUD among older Medicare beneficiaries is thought to be largely due to social isolation and instability of housing conditions. 28 Additionally, AUD had the highest proportion of self-paid encounters (8.2%), compared to seizure encounters (2.7%) and OUD encounters (5.2%).…”

Section: Discussionmentioning

confidence: 99%

Association Between Opioid Use Disorder and Seizure Incidents Among Alcohol Use Disorder Patients

et al. 2023

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Many previous studies have discussed an association between alcohol use disorder (AUD) and seizure incidents. There are also case reports of seizures during opioid withdrawals. Therefore, it is possible that AUD patients may have a higher risk of seizures if they also have opioid use disorder (OUD). However, it remains unproven whether AUD patients with a dual diagnosis of OUD have higher seizure incidents, to our knowledge. This study explored seizure incidents among the patients with a dual diagnosis of AUD and OUD as well as seizures among AUD only or OUD only patients. This study utilized de-identified data from 30 777 928 hospital inpatient encounters at 948 healthcare systems over 4 years (9/1/2018-8/31/2022) from the Vizient® Clinical Database for this study. Applying the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes, AUD (1 953 575), OUD (768 982), and seizure (1 209 471) encounters were retrieved from the database to examine the effects of OUD on seizure incidence among AUD patients. This study also stratified patient encounters for demographic factors such as gender, age, and race, as well as the Vizient-categorized primary payer. Greatest gender differences were identified among AUD followed by OUD, and seizure patient groups. The mean age for seizure incidents was 57.6 years, while that of AUD was 54.7 years, and OUD 48.9 years. The greatest proportion of patients in all 3 groups were White, followed by Black, with Medicare being the most common primary payer in all 3 categories. Seizure incidents were statistically more common ( P < .001, chi-square) in patients with a dual diagnosis of AUD and OUD (8.07%) compared to those with AUD only (7.55%). The patients with the dual diagnosis had a higher odd ratio than those with AUD only or OUD only. These findings across more than 900 health systems provide a greater understanding of seizure risks. Consequently, this information may help in triaging AUD and OUD patients in certain higher-risk demographic groups.

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Medicaid Expansion and Low-Income Adults with Substance Use Disorders

Cited by 14 publications

References 21 publications

Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states

Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states

Estimating the Prevalence of Substance Use Disorders in the US Using the Benchmark Multiplier Method

Association Between Opioid Use Disorder and Seizure Incidents Among Alcohol Use Disorder Patients

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