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

Geissler, Kimberley H. PhD; Evans, Elizabeth A. PhD

doi: 10.1097/MLR.0000000000001242
Original Article: PDF Only

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 cover 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.

Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA

Preliminary results from this study were presented in a poster presentation at the 2018 Academy Health Annual Research Meeting.

Supported by the University of Massachusetts Amherst Faculty Research Grant and School of Public Health and Health Sciences Dean’s Research Enhancement Award. E.A.E. is supported by The Greenwall Foundation, the National Institute on Drug Abuse (NIDA) UG3 DA0044830-02S1, and the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) Grant No. 1H79T1081387-01.

The authors declare no conflict of interest.

Reprints: Kimberley H. Geissler, PhD, 715 North Pleasant Street, 337 Arnold House, Amherst, MA 01003. E-mail:

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