The expansion of Medicaid under the Affordable Care Act (ACA) has had a significant impact on access to care for individuals struggling with substance use disorder (SUD). A recent study highlights that states that expanded Medicaid have seen far more low-income adults enter SUD treatment compared to states that did not. Over a four-year period, expansion states experienced nearly 40% more SUD treatment admissions, demonstrating the positive influence of healthcare coverage on behavioral health outcomes.
The Impact of Medicaid Expansion on SUD Treatment Access
The ACA Medicaid expansion aimed to improve access to care for uninsured Americans and reduce financial barriers to treatment. Researchers examining this effect focused on specialty SUD treatment programs and found that the expansion achieved these objectives. By providing coverage to low-income adults, states that opted into Medicaid expansion enabled thousands more individuals to receive the care they needed.
Data from a federal database covering 2010 to 2017 included over 11.2 million admissions to specialty SUD treatment providers. These facilities either accepted public funding or were otherwise subject to state regulation. The database allowed researchers to compare trends in SUD treatment admissions between states that expanded Medicaid and those that did not, beginning in 2014 when expansion provisions officially took effect.
Significant Increases in Treatment Admissions
Prior to Medicaid expansion, there were no notable differences between expansion and non-expansion states in terms of SUD treatment admissions. However, the year after expansion, states that expanded Medicaid saw 123.4 more SUD treatment admissions per 100,000 nonelderly adults compared to non-expansion states. By the fourth year of the expansion, this difference had increased to 283.2 more admissions per 100,000 adults, representing an approximate 36% increase.
These numbers illustrate how insurance coverage can directly influence the ability of individuals to seek treatment. Without Medicaid expansion, many low-income adults would face financial barriers preventing them from accessing critical SUD services, including outpatient treatment, residential programs, and medication-assisted treatment (MAT) for opioid use disorder (OUD).
States’ Decisions on Medicaid Expansion
The ACA allowed each state to decide whether to expand Medicaid coverage. Initially, 25 states and the District of Columbia chose to expand. Today, 37 states have opted in, providing a pathway to treatment for millions of low-income adults who otherwise would not have access to insurance coverage. Medicaid expansion eligibility includes individuals earning less than 138% of the federal poverty level, encompassing a population that historically faced limited access to behavioral health services.
By expanding coverage, states not only increase the number of people who can receive care but also improve overall public health outcomes. Increased access to SUD treatment can lead to reductions in overdose deaths, lower rates of emergency department visits, and improved social and economic stability for individuals in recovery.
Growth Across Multiple Treatment Types
Medicaid expansion did not just increase general SUD treatment admissions; it also led to higher utilization of specialized services. Expansion states reported increases in medication-assisted treatment (MAT) for OUD, as well as treatment for alcohol misuse and other substance use disorders. MAT, which combines behavioral therapy with medications such as buprenorphine or methadone, is recognized as one of the most effective treatments for opioid addiction. Expanding access to MAT has become increasingly important amid the ongoing opioid crisis, and Medicaid expansion has helped make this therapy available to more people.
The study noted that in expansion states, Medicaid now covers a higher proportion of SUD treatment admissions. Specifically, the share of admissions paid for by Medicaid increased by 23 percentage points in expansion states compared to non-expansion states. This shift underscores the role Medicaid plays in ensuring low-income individuals can access life-saving SUD care.
Implications for Public Health Policy
The results of the study emphasize the importance of policy decisions in shaping access to behavioral health services. Medicaid expansion has clearly provided a pathway for more individuals to receive treatment, which can have long-term benefits for public health. Increased treatment access not only supports recovery but also helps reduce the broader societal impacts of untreated substance use, such as criminal justice involvement, unemployment, and family instability.
States that have chosen not to expand Medicaid may need to reconsider their policies in light of these findings. Expanding access to SUD treatment can lead to a healthier population, lower healthcare costs over time, and improved quality of life for vulnerable individuals.
Conclusion
The expansion of Medicaid under the ACA has resulted in a clear and measurable increase in access to substance use disorder treatment. States that expanded coverage have seen significantly higher SUD treatment admissions, increased access to MAT, and broader treatment for alcohol and other substances. Medicaid expansion has provided thousands of low-income adults with the opportunity to receive critical care, demonstrating the powerful role health policy plays in addressing behavioral health crises.
As more states adopt Medicaid expansion and refine their programs, it is likely that access to SUD treatment will continue to improve. The data highlights the importance of reducing financial barriers to care and ensuring that all individuals, regardless of income, have the opportunity to seek treatment for substance use disorders. With sustained support and policy innovation, the positive trends in treatment access are expected to continue, offering hope for millions of individuals and families affected by substance use disorders.
Medicaid expansion serves as a strong example of how health policy can directly impact the ability of individuals to obtain essential treatment, underscoring the importance of continued advocacy for comprehensive coverage and access to behavioral health services nationwide.
