The relationship of Medicaid expansion to psychiatric comorbidity care within substance use disorder treatment programs
Open accessAbstract
Background Co-occurring mental health disorders are common among substance use disorder (SUD) patients. Medicaid expansion aimed to reduce barriers to SUD and mental health care and thereby improve treatment outcomes. Methods We estimated change in the proportion of United States SUD treatment sites offering treatment for psychiatric comorbidities following Medicaid expansion as part of implementation of the Affordable Care Act (ACA) in 2014. Using panel data from the 2013-2014, n = 660, and 2016-2017, n = 638, waves of the National Drug Abuse Treatment System Survey (NDATSS), we estimated change in the proportion of sites offering antidepressant medication, other psychiatric medication, behavioral treatment, or any combination thereof for treatment of mental health comorbidities (i.e., beyond services focused on SUD). We modeled the impact of Medicaid expansion as an interaction between year and date of Medicaid expansion. We constructed a mixed-effects linear regression model for each outcome, with the interaction variable as the main exposure, site as a random effect, and site's average duration of treatment, proportion of clients with psychiatric comorbidities, average caseload per treatment prescribing-clinician on staff, type of facility and geographic region as covariates, to estimate a difference-in-differences (D-I-D) equation. Results The adjusted D-I-D analysis indicated that the proportion of SUD treatment sites offering antidepressants for psychiatric treatment increased 10% (95% CI 1%, 18%) in the Medicaid expansion sites compared to non-expansion sites. The D-I-D for other psychiatric medications was also 10% (95% 1%, 19%). No significant changes were observed in behavioral treatment or the combination measure. The strongest association between Medicaid expansion and offering medication for mental health comorbidities was the 34% increase observed for residential treatment settings (95% CI 10%, 59%). Conclusion Availability of psychiatric medication treatment in SUD treatment settings increased following Medicaid expansion, particularly in residential SUD facilities. This policy change has facilitated integrated treatment for the substantial share of SUD treatment patients with mental health comorbidities, with the greatest benefit for patients receiving SUD treatment in residential programs.
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The ACA appears to have improved coverage for SUD and psychiatry care.
“Evidence suggests a positive impact of the ACA on both SUD and psychiatry coverage (Cowell, Prakash, Jones, Barnosky, & Wedehase, 2018; Novak, Anderson, & Chen, 2018; Shover, Abraham, D’Aunno, Friedmann, & Humphreys, 2019), including an increase in insurance choices (Abraham et al., 2017; Andrews et al., 2018; Feder et al., 2017).”
From Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system (2020) · cites this paper as Shover, Abraham, D’Aunno, Friedmann, & Humphreys, 2019
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Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act
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Cited by
Sorted by citations
Satre, D. D., Palzes, V. A., Young-Wolff, K. C., Parthasarathy, S., Weisner, C., Guydish, J., & Campbell, C. I. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.108097 · Cited by 22 · see citing works
“Evidence suggests a positive impact of the ACA on both SUD and psychiatry coverage (Cowell et al., 2018; Novak et al., 2018; Shover et al., 2019), including an increase in insurance choices (Abraham et al.”
Background
- Authors
- Shover, C. L., Abraham, A., D'Aunno, T., Friedmann, P. D., & Humphreys, K.
- Affiliations
- Stanford University (US)
- University of Georgia (US)
- University of Massachusetts Chan Medical School (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Shover, Chelsea L.
- Abraham, Amanda
- Friedmann, Peter D.
- Humphreys, Keith
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 105
- Pages
- 44-50
- ISSN
- 0740-5472 (ISSN-L)
- PMC
- PMC9018113
- OpenAlex
- W2965454790
- Cited by
- 10
- References
- 4
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 1
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (T32 DA035165)
- National Institutes of Health
- Wu Tsai Neurosciences Institute
- Stanford University
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- Medicaid expansion, addiction treatment, psychiatric comorbidity, co-occurring disorders, Affordable Care Act, antidepressants, psychiatric medication, behavior therapy, residential treatment, integrated treatment, access to mental health care
- MeSH terms
- Mental Disorders, Humans, Medicaid, Patient Acceptance of Health Care, Surveys and Questionnaires, Residential Treatment, United States, Comorbidity, Substance-Related Disorders, Patient Protection and Affordable Care Act
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