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. 2022 Nov 1;60(11):806-812.
doi: 10.1097/MLR.0000000000001768. Epub 2022 Aug 26.

Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography

Margarita Alegría  1   2   3 , Irene Falgas-Bague  1   2 , Marie Fukuda  1 , Jenny Zhen-Duan  1   2 , Cole Weaver  4 , Isabel O'Malley  1 , Timothy Layton  4 , Jacob Wallace  5 , Lulu Zhang  1 , Sheri Markle  1 , Pat Lincourt  6 , Shazia Hussain  6 , Roberto Lewis-Fernández  7   8 , Dolly A John  8 , Thomas McGuire  4
Affiliations

Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography

Margarita Alegría et al. Med Care. .

Abstract

Objective: The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC).

Data source: Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC.

Research design: We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities.

Results: We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures.

Conclusions: Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.

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Conflict of interest statement

T.L. reports grant funding from the Agency for Healthcare Research and Quality. J.W. reports a relationship to Medicaid Transformation and Financing at Aurrera Health Group. R.L.F. reports institutional support from the New York State Psychiatric Institute and the Office of Mental Health. The remaining authors declare no conflict of interest.

References

    1. American’s Health Insurance Plans. Ensuring Access to Quality Behavioral Health Care: Health Plan Examples. American’s Health Insurance Plans (AHIP); 2016.
    1. Guerrero EG. Enhancing access and retention in substance abuse treatment: The role of Medicaid payment acceptance and cultural competence. Drug and Alcohol Dependence. 2013;132(3):555–561. doi: 10.1016/j.drugalcdep.2013.04.005 - DOI - PubMed
    1. Kilaru AS, Xiong A, Lowenstein M, et al. Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients. JAMA Netw Open. 2020;3(5):e205852. doi: 10.1001/jamanetworkopen.2020.5852 - DOI - PMC - PubMed
    1. Yang J, Landrum MB, Zhou L, Busch AB. Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts. Gen Hosp Psychiatry. 2020;67:100–106. doi: 10.1016/j.genhosppsych.2020.09.004 - DOI - PMC - PubMed
    1. Acevedo A, Panas L, Garnick D, et al. Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter? J Behav Health Serv Res. 2018;45(4):533–549. doi: 10.1007/s11414-018-9586-y - DOI - PMC - PubMed

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