The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

Abstract

We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid‐reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event‐study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post‐expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.

Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment

“…59,99 As an increasing number of patients with OUDs have behavioral health insurance coverage, more patients may be accessing care, including in physician offices. 30,100–104 However, robust evidence does not yet establish clearly improved behavioral health outcomes attributable to these policy changes, perhaps because further follow-up time is needed. 100 Also, the treatment gap remains because of the growing population of patients with OUDs and persistently low number of providers.…”

Evaluating the role of Section 1115 waivers on Medicaid coverage and utilization of opioid agonist therapy among substance use treatment admissions

“…The results of this study are also consistent with research that has examined the impact of Medicaid expansion brought about through implementation of the ACA. For example, a study assessing the impact of Medicaid expansion under the ACA on substance use disorder treatment utilization and financing using TEDS‐A (2010‐2015) found that Medicaid insurance coverage and Medicaid as a form of payment increased in expansion states compared to nonexpansion states . Another study found a rise in opioid treatment admissions in states that expanded Medicaid under the ACA and concluded that this increase was driven by the increase in opioid treatment admissions covered by Medicaid .…”

“…TEDS includes facility data from state administrative systems and therefore is impacted by administrative changes that can impact missingness of data. However, we used an approach to excluding missing data similar to that used in previous studies of insurance data in the TEDS‐A, and further attempted to account for this in both primary and sensitivity analyses.…”

The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion

“…Among young adults, Medicaid coverage rates increased by about 5 percentage points in 2014 and 9 in 2015 (Wehby and Lyu, 2018). Furthermore, Medicaid coverage was also found to increase substantially for subpopulations of individuals with opioid or other substance abuse issues (Feder et al, 2017;Maclean and Saloner, 2019;Meinhofer and Witman, 2018) as well as individuals with histories of involvement with the criminal justice system Winkelman et al (2016), 3 and those with both history of justice system involvement and substance abuse disorders (Saloner et al, 2016). Furthermore, Medicaid coverage was also found to increase substantially for subpopulations of individuals with opioid or other substance abuse issues (Feder et al, 2017;Maclean and Saloner, 2019;Meinhofer and Witman, 2018) as well as individuals with histories of involvement with the criminal justice system Winkelman et al (2016), 3 and those with both history of justice system involvement and substance abuse disorders (Saloner et al, 2016).…”

“…Furthermore, Medicaid coverage was also found to increase substantially for subpopulations of individuals with opioid or other substance abuse issues (Feder et al, 2017;Maclean and Saloner, 2019;Meinhofer and Witman, 2018) as well as individuals with histories of involvement with the criminal justice system Winkelman et al (2016), 3 and those with both history of justice system involvement and substance abuse disorders (Saloner et al, 2016). Surprisingly, though, the literature has found mixed results regarding whether the increases in Medicaid coverage for those with substance abuse problems resulted in additional substance addiction treatment (Feder et al, 2017;Maclean and Saloner, 2019;Meinhofer and Witman, 2018;Saloner et al, 2016). Surprisingly, though, the literature has found mixed results regarding whether the increases in Medicaid coverage for those with substance abuse problems resulted in additional substance addiction treatment (Feder et al, 2017;Maclean and Saloner, 2019;Meinhofer and Witman, 2018;Saloner et al, 2016).…”