In a recent examination of data from both pre- and post-Medicaid expansion, analysts found a link between expanded Medicaid options for very low-income populations and a reduction in deaths related to substance use disorders (SUDs).
The study, which was published in JAMA Network Open, looks at data from the Centers for Disease Control and Prevention between 2002 and 2015. It found that the mean number of SUD-related deaths in that time period was 21.15 per every 100,000 people.
Over the course of those 14 years, the number increased from 16 people to 27.5 people per every 100,000, while the average Medicaid eligibility threshold also increased from 87.2% of the federal poverty level to 97.1%.
Specifically, every one percentage point increase in Medicaid eligibility was associated with about 1.4 fewer SUD-related deaths per 100,000 residents, a 6.5% reduction overall. In the 28 states that increased eligibility thresholds for Medicaid over the 14 years, an estimated 1,045 SUD-related deaths may have been prevented.
In addition, the study dives into demographic data. The researchers found that 13% of the SUD-related deaths in that time period were among blacks, 51% were female and 13% were aged 65 or older.
The study’s authors conclude that the increase in SUD-related deaths during this time period may have been even greater if not for the broadening of Medicaid eligibility and that in the future, expanded Medicaid coverage may be one tool to help reduce SUD-related deaths.
“There has been speculation in several circles that Medicaid has helped fuel the opioid crisis by subsidizing drug use. Our findings suggest the opposite: Access to healthcare could be an important policy tool in limiting deaths due to overdoses,” Dana Goldman, Ph.D., a professor at the University of Southern California, consultant to Precision Health Economics and one of the study's authors, told FierceHealthcare.
Since the mid-1980s alone, the number of SUD-related deaths has increased threefold. In addition, more than 60% of drug overdose deaths in 2014 were caused by an opioid. And between 1999 and 2015, deaths due to prescription drugs increased by 295%—many of which are attributed to opioids.
Medicaid has historically been one of the biggest payers of SUD and mental health treatments. In fact, the Affordable Care Act made mental health insurance coverage mandatory.
In 2015, Minnesota had the highest eligibility threshold, 205% of the federal poverty level. And if all states with Medicaid eligibility thresholds below Minnesota’s had increased to 205%, there may have been 5,207 fewer deaths in 2015, a 5.89% reduction. Similarly, if states with thresholds below 133% of the federal poverty level had increased their thresholds to 133%, there may have been 2,359 fewer SUD-related deaths, a reduction of 2.67% in 2015.
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“Mental health parity, mandatory minimum sentencing, and good Samaritan laws showed negligible evidence of association with SUD-related deaths,” the study concluded. “While individual SUD treatment and overdose prevention programs have demonstrated reductions of SUD-related deaths at a local level, broader Medicaid eligibility may affect more patients with SUDs and the overall health care system.”
The authors did note the challenges associated with expanded Medicaid such as the additional costs to state and federal governments. Plus, the funding comes primarily from taxation, and the populations that may benefit from expanded Medicaid are likely not those funding it.
“Medicaid is an important policy tool in fighting opioid addiction. Lack of healthcare access is probably driving people further into illegal substance abuse, which will make it even harder to address the crisis,” Goldman added.