Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use | Addiction Medicine | JAMA Internal Medicine | JAMA Network
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    Original Investigation
    March 23, 2020

    Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use

    Author Affiliations
    • 1Harvard Pilgrim Health Care Institute, Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
    • 2School of Public Affairs, Department of Public Administration and Policy, American University, Washington, DC
    • 3O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana
    • 4College of Public Health, Department of Health Management & Policy, University of Kentucky, Lexington, Kentucky
    • 5National Bureau of Economic Research, Cambridge, Massachusetts
    • 6Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
    JAMA Intern Med. 2020;180(5):753-759. doi:10.1001/jamainternmed.2020.0473
    Key Points

    Question  Is there an association between post-2014 Medicaid expansions and rates of opioid-related emergency department visits and inpatient hospitalizations?

    Findings  In this difference-in-differences study evaluating institutions in 46 states and the District of Columbia, the post-2014 Medicaid expansions were associated with a statistically significant 9.7% reduction in the rate of opioid-related inpatient hospitalizations. There did not appear to be any associations between the pre-2014 or post-2014 Medicaid expansions on the rate of opioid-related emergency department visits.

    Meaning  Expanding Medicaid may be useful for reducing opioid-related hospitalizations, possibly owing to better management of opioid use disorder in outpatient settings among the newly insured population.

    Abstract

    Importance  The rate of opioid-related emergency department (ED) visits and inpatient hospitalizations has increased rapidly in recent years. Medicaid expansions have the potential to reduce overall opioid-related hospital events by improving access to outpatient treatment for opioid use disorder.

    Objective  To examine the association between Medicaid expansions and rates of opioid-related ED visits and inpatient hospitalizations.

    Design, Setting, and Participants  A difference-in-differences observational design was used to compare changes in opioid-related hospital events in US nonfederal, nonrehabilitation hospitals in states that implemented Medicaid expansions between the first quarter of 2005 and the last quarter of 2017 with changes in nonexpansion states. All-payer ED and hospital discharges from 45 states in the Healthcare Cost and Utilization Project FastStats were included.

    Exposures  State implementation of Medicaid expansions between 2005 and 2017.

    Main Outcomes and Measures  Rates of all opioid-related ED visits and inpatient hospitalizations, measured as the quarterly numbers of treat-and-release ED discharges and hospital discharges related to opioid abuse, dependence, and overdose, per 100 000 state population.

    Results  In the 46 states and District of Columbia included in the study, 1524 observations of emergency department data and 2219 observations of opioid-related inpatient hospitalizations were analyzed. The post-2014 Medicaid expansions were associated with a 9.74% (95% CI, −18.83% to −0.65%) reduction in the rate of opioid-related inpatient hospitalizations. There appeared to be no association between the pre-2014 or post-2014 Medicaid expansions and the rate of opioid-related ED visits (post-2014 Medicaid expansions, −3.98%; 95% CI, −14.69% to 6.72%; and pre-2014 Medicaid expansions, 1.02%; 95% CI, −5.25% to 7.28%).

    Conclusions and Relevance  Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use, possibly attributable to improved care for opioid use disorder in other settings.

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