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Articles   |    
Characteristics of Adults With Substance Use Disorders Expected to Be Eligible for Medicaid Under the ACA
Susan H. Busch, Ph.D.; Ellen Meara, Ph.D.; Haiden A. Huskamp, Ph.D.; Colleen L. Barry, Ph.D., M.P.P.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200011
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Dr. Busch is with the Department of Health Policy and Management, Yale School of Public Health, P.O. Box 208034, Suite 300, New Haven, CT 06520-8034 (e-mail: susan.busch@yale.edu). Dr. Meara is with the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, and the National Bureau of Economic Research, Cambridge, Massachusetts. Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Barry is with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Some of the data reported here were presented at the AcademyHealth annual research meeting, June 12–14, 2011, Seattle.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objectives  Provisions in the Affordable Care Act (ACA) are likely to expand access to substance use disorder treatment for low-income individuals. The aim of the study was to provide information on the need for substance use disorder treatment among individuals who may be eligible for Medicaid under the ACA.

Methods  The 2008 and 2009 National Survey on Drug Use and Health provided data on demographic characteristics, health status, and substance use disorders for comparison of current low-income Medicaid enrollees (N=3,809) with currently uninsured individuals with household incomes that may qualify them for Medicaid coverage beginning in 2014 (N=5,049). The incomes of the groups compared were 138% of the federal poverty level (133% provided in the ACA plus a 5% income “disregard” allowed by the law).

Results  The rate of substance use disorders among currently uninsured income-eligible individuals was slightly higher than the rate among current Medicaid enrollees (14.6% versus 11.5%, p=.03). Although both groups had significant unmet need for substance use disorder treatment, the treatment rate among those who needed treatment was significantly lower in the income-eligible group than in the currently enrolled group (31.3% versus 46.8%, p<.01). When the analysis excluded informal care received outside the medical sector, treatment rates among those with treatment needs were much lower in both groups (12.8% in the income-eligible group and 30.7% among current enrollees).

Conclusions  Findings suggest that Medicaid insurance expansions under the ACA will reduce unmet need for substance use disorder treatment.

Abstract Teaser
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Table 1Individuals with household incomes ≤138% of the federal poverty level with and without a substance use disorder, by current insurance status, 2008–2009a
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a Source: National Survey on Drug Use and Health, 2008–2009. Ns are unweighted and percentages are weighted to make estimates representative of the noninstitutionalized population. The income eligibility threshold reflects 133% of the federal poverty level provided in the Affordable Care Act plus a 5% income “disregard” allowed by the law.

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b Insurance categories are defined to be mutually exclusive and exhaustive. Therefore, columns sum to 100%.

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c Individuals with symptoms of both dependence and abuse were coded as dependent.

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d Includes individuals currently reporting coverage by TRICARE, CHAMPUS, CHAMPVA, the Department of Veterans Affairs, or military health care

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e p<.01 for the difference in insurance distribution between individuals with and without a substance use disorder; p=.08 for the difference in insurance distribution between individuals with alcohol or illicit drug dependence and individuals with alcohol or illicit drug abuse

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Table 2Characteristics of currently uninsured individuals expected to be income eligible for Medicaid and current Medicaid enrollees, both with household incomes ≤138% of the federal poverty levela
Table Footer Note

a Source: National Survey on Drug Use and Health, 2008–2009. Ns are unweighted and percentages are weighted to make estimates representative of the noninstitutionalized population. The income eligibility threshold reflects 133% of the federal poverty level provided in the Affordable Care Act plus a 5% income “disregard” allowed by the law.

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b Individuals reporting both Medicare and Medicaid coverage were not included as current Medicaid enrollees.

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c Includes both alcohol or illicit drug abuse or dependence. Individuals with symptoms of both dependence and abuse were coded as dependent.

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d Includes individuals with a current substance use disorder as well as those with no current substance use disorder who received substance use disorder treatment in the past 12 months. Thus this group includes some individuals with no current dependence or abuse.

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Table 3Receipt of substance use disorder treatment among currently uninsured individuals expected to be income eligible for Medicaid and current Medicaid enrollees, both with household incomes less than 138% of the federal poverty levela
Table Footer Note

a Source: National Survey on Drug Use and Health, 2008–2009. Ns are unweighted and percentages are weighted to make estimates representative of the noninstitutionalized population. The income eligibility threshold reflects 133% of the federal poverty level provided in the Affordable Care Act plus a 5% income “disregard” allowed by the law.

Table Footer Note

b Individuals reporting both Medicare and Medicaid coverage were not included as current Medicaid enrollees.

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c Includes individuals with a current substance use disorder as well as those with no current substance use disorder who received substance use disorder treatment in the past 12 months. Thus this group includes some individuals with no current dependence or abuse.

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d Includes both outpatient and inpatient treatment

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Table 4Characteristics of currently uninsured individuals expected to be income eligible for Medicaid and current Medicaid enrollees, both with household incomes less than 138% of the federal poverty level, by substance use disorder statusa
Table Footer Note

aSource: National Survey on Drug Use and Health, 2008–2009. Ns are unweighted and percentages are weighted to make estimates representative of the noninstitutionalized population. The income eligibility threshold reflects 133% of the federal poverty level provided in the ACA plus a 5% income “disregard” allowed by the law.

Table Footer Note

b Individuals reporting both Medicare and Medicaid coverage were not included as current Medicaid enrollees.

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c Includes both alcohol and illicit drug abuse or dependence

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d Individuals with symptoms of both dependence and abuse were coded as dependent.

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