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Abstract
BackgroundThe study examined the association of the Affordable Care Act’s 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients.MethodsLogistic regression analysis examined utilization of care before (January 1, 2010–December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014–December 31, 2016).ResultsAdult membership in the Oregon Health Plan (Medicaid) increased 180% following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69% to 65%) and the percent of individuals receiving pharmacotherapy (57% to 45%) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41%; 2014 = 33%). Odds of accessing any psychosocial service increased by 8% per year from 2010 to 2013 (AOR = 1.08; 95% CI 1.06–1.11) with an 18% immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95% CI 0.76–0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8% per year (2014 through 2016) (AOR = 1.08; 95% CI 1.06–1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36% (AOR = 0.64; 95% CI 0.60–0.68) decline in 2014, and a 13% increase per year in 2015 and 2016 (AOR = 1.13; 95% CI 1.09–1.16).ConclusionThe number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon’s Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.
Highlights
The study examined the association of the Affordable Care Act’s 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients
The 2014 Medicaid expansion reduced the uninsured rate in Oregon and facilitated potential access to treatment for people with opioid use disorders
Numbers diagnosed with opioid use disorder Medicaid expansion was associated with a 1.8-fold increase in adults enrolled in Oregon Medicaid comparing 2013 (n =172,539) to 2014 (n = 482,081)
Summary
The study examined the association of the Affordable Care Act’s 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients. The Affordable Care Act and its expansion of Medicaid eligibility promoted increased coverage for health care and improved access to treatment for alcohol, opioid, and other drug use disorders. Analyses of responses to the National Survey on Drug Use and Health reported reductions in people without insurance but no increase. The 2014 Medicaid expansion reduced the uninsured rate in Oregon and facilitated potential access to treatment for people with opioid use disorders. Analyses assessed change overtime in access to treatments for opioid use disorders on both the number in care and the relative distribution of where care occurred
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