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The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum

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Abstract

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states (\(\beta \)=−0.038, SE = 0.005, p < 0.0001) than in expansion states (\(\beta \)=−0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.

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Authors and Affiliations

  1. Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    George Pro

  2. Center for Rural Health, Oklahoma State University, Tulsa, OK, USA

    Zach Giano, Denna Wheeler & Randolph D. Hubach

  3. Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, AZ, USA

    Ricky Camplain & Julie A. Baldwin

  4. Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA

    Ricky Camplain & Julie A. Baldwin

  5. Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA

    Shane Haberstroh

  6. Center for Health Equity Research, Northern Arizona University, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA

    Carly Camplain & Julie A. Baldwin

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  1. George Pro
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  2. Zach Giano
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  3. Ricky Camplain
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  4. Shane Haberstroh
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  5. Carly Camplain
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  6. Denna Wheeler
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  7. Randolph D. Hubach
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  8. Julie A. Baldwin
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Corresponding author

Correspondence to George Pro.

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All authors report no conflicts of interest.

Research involving Human Participants and/or Animals

This study does not involve human participants. It is a secondary analysis of publicly available data through the Substance Abuse and Mental Health Services Administration (the National Survey of Substance Abuse Treatment Services; N-SSATS). N-SSATS includes data that describes characteristics of treatment clinics (i.e., number of beds, forms of payment accepted, integration of mental health services), not individual patients.

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Informed consent is not applicable to this study, as it is a secondary analysis of pre-existing, publicly available clinic-level data.

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Pro, G., Giano, Z., Camplain, R. et al. The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum. Community Ment Health J 57, 1017–1022 (2021). https://doi.org/10.1007/s10597-020-00719-z

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  • DOI: https://doi.org/10.1007/s10597-020-00719-z

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