Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders

Extensive undertreatment of substance use disorders has focused attention on whether the expansion of eligibility for Medicaid under the Affordable Care Act (ACA) has promoted increased coverage and treatment of these disorders. We assessed changes in coverage and substance use disorder treatment am...

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Bibliographic Details
Published in:Health Affairs 2018-08, Vol.37 (8), p.1208-1215
Main Authors: Olfson, Mark, Wall, Melanie, Barry, Colleen L., Mauro, Christine, Mojtabai, Ramin
Format: Article
Language:English
Subjects:
Adults
Alcohol
Alcohol use
Cocaine
Disorders
Drug abuse
Drug use
Focused attention
Government programs
Health insurance
Health services
Heroin
Households
Income
Indigent care
Insurance
Insurance coverage
Integrated care
Internet
Interviews
Labor economics
Low income groups
Marijuana
Medicaid
Medical treatment
Mental disorders
Mental health
Narcotics
Patient Protection & Affordable Care Act 2010-US
Polls & surveys
Poverty
Residents
Response rates
Services
Sociodemographics
Substance abuse treatment
Substance use
Substance use disorder
Trends
Uninsured people
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Summary:Extensive undertreatment of substance use disorders has focused attention on whether the expansion of eligibility for Medicaid under the Affordable Care Act (ACA) has promoted increased coverage and treatment of these disorders. We assessed changes in coverage and substance use disorder treatment among low-income adults with the disorders following the 2014 ACA Medicaid expansion, using data for 2008-15 from the National Survey on Drug Use and Health. The percentage of low-income expansion state residents with substance use disorders who were uninsured decreased from 34.4 percent in 2012-13 to 20.4 percent in 2014-15, while the corresponding decrease among residents of nonexpansion states was from 45.2 percent to 38.6 percent. However, there was no corresponding increase in overall substance use disorder treatment in either expansion or nonexpansion states. The differential increase in insurance coverage suggests that Medicaid expansion contributed to insurance gains, but corresponding treatment gains were not observed. Increasing treatment may require the integration of substance use disorder treatment with other medical services and clinical interventions to motivate people to engage in treatment.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2018.0124