The Relationship of State Medicaid Coverage to Medicaid Acceptance Among Substance Abuse Providers in the United States

Article

Abstract

The Affordable Care Act will dramatically increase the number of Americans with Medicaid coverage for substance abuse treatment (SAT). Currently, few SAT providers accept Medicaid, and consequently, there is concern that newly-eligible Medicaid enrollees will have difficulty finding SAT providers willing to serve them. However, little is known about why few SAT providers accept Medicaid. In response, this study examines how features of state Medicaid coverage for SAT, including benefits, eligibility, and oversight, are associated with Medicaid acceptance among SAT providers. Medicaid acceptance was positively associated with the number of SAT services covered, and the number of optional categorical expansions implemented by the state. Requirements for physician involvement were associated with lower odds of acceptance. The results suggest that more generous Medicaid coverage may encourage SAT providers to accept Medicaid, but regulatory policies may inhibit their ability to do so.

References

  1. 1.
    Congressional Budget Office. Updated Budget Projections: Fiscal Years 20132023. Washington: Congressional Budget Office; 2013.Google Scholar
  2. 2.
    Congressional Budget Office. Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision. Washington: Congressional Budget Office; 2013.Google Scholar
  3. 3.
    Buck JA. The looming expansion and transformation of public substance abuse treatment under the affordable care act. Health Affairs 2011;30: 1402-1410.PubMedCrossRefGoogle Scholar
  4. 4.
    Donohue JM, Garfield RL, Lave, JR. The impact of expanded health insurance coverage on individuals with mental illnesses and substance use disorders. Washington: Department of Health and Human Services, 2012.Google Scholar
  5. 5.
    Capoccia VA, Grazier KL, Toal C, et al. Massachusetts’s experience suggests coverage alone is insufficient to increase addiction disorders treatment. Health Affairs 2012;31(5): 1000-1008.PubMedCrossRefGoogle Scholar
  6. 6.
    Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. Rockville: Substance Abuse and Mental Health Services Administration, 2012.Google Scholar
  7. 7.
    Garfield RL, Lave JR, Donohue JM. Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services 2010; 61(11): 1081-1086.PubMedCrossRefGoogle Scholar
  8. 8.
    Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Data on Substance Abuse Treatment Facilities. Rockville: Substance Abuse and Mental Health Services Administration, 2011.Google Scholar
  9. 9.
    Baker L, Royalty, AB. Medicaid policy, physician behavior, and health care for the low-income population. The Journal of Human Resources 1998;35(3): 480-502.CrossRefGoogle Scholar
  10. 10.
    Berman S, Dolins J, Tang SF, et al. Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics, 2002;110: 239-248.PubMedCrossRefGoogle Scholar
  11. 11.
    Davidson SM. Physician participation in Medicaid: background and issues. Journal of Health Politics, Policy and the Law 1982;6(4), 703-717.CrossRefGoogle Scholar
  12. 12.
    Gabel JR, Rice TH. Reducing public expenditures for physicians services: the price of paying less. Journal of Health Politics, Policy and the Law 1985;9: 595-609.CrossRefGoogle Scholar
  13. 13.
    Hadley J. Physician participation in Medicaid: evidence from California. Health Services Research 1979;4: 266-280.Google Scholar
  14. 14.
    Mitchell J. Physician participation in Medicaid revisited. Medical Care 1991;29(7): 645-653.PubMedCrossRefGoogle Scholar
  15. 15.
    Perloff JD, Kletke PR, Neckerman KM. Recent trends in pediatrician participation in Medicaid. Medical Care 1986;24(8):749–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Sloan F, Mitchell J, Cromwell J. Physician participation in state Medicaid programs. Journal of Human Resources 1978;13: 211-245.PubMedCrossRefGoogle Scholar
  17. 17.
    Stewart M, Horgan C. Health services and financing of treatment. Alcohol Research & Health 2011;33: 389-394.Google Scholar
  18. 18.
    Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer. Washington: Kaiser Family Foundation.Google Scholar
  19. 19.
    Mark, TL, Levitt, KR, Vandivort-Warren, R, et al. Changes in US spending on mental health and substance abuse treatment, 1986–2005, and implications for policy. Health Affairs 2011;30(2): 284–292.PubMedCrossRefGoogle Scholar
  20. 20.
    McElrath T, Chriqui JF, McBride DC. Factors related to Medicaid payment acceptance at outpatient substance abuse treatment programs. Health Services Research 2011;46(2): 632-653.CrossRefGoogle Scholar
  21. 21.
    Fossett JW, Peterson JA. Physician supply and Medicaid participation. The causes of market failure. Medical Care 1989; 27(4): 386–396.PubMedCrossRefGoogle Scholar
  22. 22.
    Fossett JW, Peterson JA, Ring MC. Public sector primary care and Medicaid: trading accessibility for mainstreaming. Journal of Health Politics, Policy and Law 1989;14(2): 309-325.PubMedCrossRefGoogle Scholar
  23. 23.
    Greene J, Blustein J, Weitzman BC. Race, segregation, and physicians’ participation in Medicaid. Milbank Quarterly 2006;84(2): 239-272.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    D’Aunno T. The role of organization and management in substance abuse treatment: review and roadmap. Journal of Substance Abuse Treatment 2006;31(3): 221-233.PubMedCrossRefGoogle Scholar
  25. 25.
    Mark TL, Levit KR, Vandivort-Warren R, et al. Trends in spending for substance abuse treatment, 1986–2003. Health Affairs 2007;26(4): 1118-1128.PubMedCrossRefGoogle Scholar
  26. 26.
    McLellan AT, Carise D, Kleber HD. Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment 2003;25(2): 117-121.PubMedCrossRefGoogle Scholar
  27. 27.
    Mulvey KP, Hubbard S, Hayashi S. A national study of the substance abuse treatment workforce. Journal of Substance Abuse Treatment 2003;24(1): 51-57.PubMedCrossRefGoogle Scholar
  28. 28.
    Robinson G, Kaye N, Bergman D, et al. State Profiles of Mental Health and Substance Abuse Services in Medicaid. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2003.Google Scholar
  29. 29.
    Substance Abuse and Mental Health Services Administration. (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4062). RockvilleGoogle Scholar
  30. 30.
    U.S. Census Bureau. Census 2000, Summary File 1. Retrieved from http://factfinder2.census.gov, 2000.
  31. 31.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS): 2003. Data on Substance Abuse Treatment Facilities. Rockville, 2004.Google Scholar
  32. 32.
    Zuckerman S, McFeeters J, Cunningham P, et al. Changes in Medicaid physician fees, 1998–2003: implications for physician participation. Health Affairs 2004;W4: 374-384. Google Scholar
  33. 33.
    Wooldridge JM. Econometric analysis cross section and panel data. Cambridge: MIT Press, 2002.Google Scholar
  34. 34.
    Rubin DB. Multiple Imputation for nonresponse in surveys. New York: Wiley, 1987.Google Scholar
  35. 35.
    Schaefer JL. Analysis of incomplete multivariate data. New York: Chapman & Hall, 1997.CrossRefGoogle Scholar
  36. 36.
    Harel O. The estimation of R2 and adjusted R2 in incomplete data sets using multiple imputation. Journal of Applied Statistics 2009;36(10): 1109-1118.CrossRefGoogle Scholar
  37. 37.
    Grogan CM, Patashnik E. Between welfare medicine and mainstream entitlement: Medicaid at the political crossroads. Journal of Health Politics, Policy and Law 2003;28(5): 821-858.PubMedCrossRefGoogle Scholar
  38. 38.
    Deck DD, McFarland BH, Titus JM, et al. (2000). Access to substance abuse treatment services under the Oregon health plan. Journal of the American Medical Association 2000;284(16): 2093-2099.PubMedCrossRefGoogle Scholar
  39. 39.
    McCarty D, & Argeriou M. (2003). The Iowa managed substance abuse care plan: access, utilization, and expenditures for Medicaid recipients. The Journal of Behavioral Health Services and Research 2003;30(1): 18-25.PubMedCrossRefGoogle Scholar
  40. 40.
    Callahan JJ, Shepard DS, Beinecke RH., et al. Mental health/substance abuse treatment in managed care: the Massachusetts Medicaid experience. Health Affairs 1995;14(3): 173-184.PubMedCrossRefGoogle Scholar
  41. 41.
    Ettner S, Denmead G, Dilonardo J, et al. The impact of managed care on the substance abuse treatment patterns and outcomes of Medicaid beneficiaries: Maryland’s health choice program. Journal of Behavioral Health Services and Research 2003;30(1): 41-62.PubMedCrossRefGoogle Scholar
  42. 42.
    Hodgkin D., Shepard D, Anthony, Y., et al. A publicly managed Medicaid substance abuse carve-out: effects on spending and utilization. Administration and Policy in Mental Health and Mental Health Services Research 2004;31(3): 197-217.PubMedCrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2014

Authors and Affiliations

  1. 1.College of Social WorkUniversity of South CarolinaColumbiaUSA

Personalised recommendations