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Observational Study
. 2020 Feb;58(2):101-107.
doi: 10.1097/MLR.0000000000001242.

Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity

Kimberley H Geissler  1 , Elizabeth A Evans
Affiliations
Observational Study

Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity

Kimberley H Geissler et al. Med Care. 2020 Feb.

Abstract

Background: Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid.

Objectives: To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity).

Research design: Observational study using an interrupted time series design.

Subjects: 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics.

Measures: Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance.

Results: Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs.

Conclusions: After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.

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Conflict of interest statement

COI: No potential conflicts of interest exist for the authors.

Figures

Figure 1:
Figure 1:
Changes in Medicaid acceptance over time by substance use disorder treatment facilities (2002–2013) Notes: 95% confidence intervals calculated using standard errors adjusted for clustering at the state level shown. Sample size is 83,284 facility-year observations for main sample described in text. Controls include state fixed effects, indicators of ownership type, facility size indicators, located in a hospital, licensing status, accreditation status, and offering no charge or free treatment, an opioid treatment program, outpatient substance use services, residential (non-hospital) substance use services, hospital inpatient services, treatment in language other than English, and state characteristics (located in state with above median 2009 Medicaid managed care penetration, percent unemployed, percent Hispanic, percent Black, percent White, percent with SUD, percent with Medicaid, percent with Medicare, and total population).
Figure 2:
Figure 2:
Percent of substance use treatment facilities accepting Medicaid by state (2013) Notes: Sample size is 8,185 facilities for main sample as described in text. States with no data are those with early Medicaid expansion, which are excluded from the main sample.
See this image and copyright information in PMC

References

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