Medicaid Expansion and Low-Income Adults with Substance Use Disorders

Mark Olfson, Melanie Wall, Colleen L. Barry, Christine Mauro, Tianshu Feng, Ramin Mojtabai

Research output: Contribution to journalArticlepeer-review


Problems accessing affordable treatment are common among low-income adults with substance use disorders. A difference-in-differences analysis was performed to assess changes in insurance and treatment of low-income adults with common substance use disorders following the 2014 ACA Medicaid expansion, using data from the 2008–2017 National Surveys on Drug Use and Health. Lack of insurance among low-income adults with substance use disorders in expansion states declined from 34.8% (2012–2013) to 20.0% (2014–2015) to 13.5% (2016–2017) while Medicaid coverage increased from 24.8% (2012–2013) to 48.0% (2016–2017). In nonexpansion states, lack of insurance declined from 44.8% (2012–2013) to 34.2% (2016–2017) and Medicaid coverage increased from 14.3% (2012–2013) to 23.4% (2016–2017). Treatment rates remained low and little changed. Medicaid expansion contributed to insurance coverage gains for low-income adults with substance use disorders, although persistent treatment gaps underscore clinical and policy challenges of engaging these newly insured adults in treatment.

Original languageEnglish (US)
JournalJournal of Behavioral Health Services and Research
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

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