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Did the Medicaid Expansion Crowd Out Other Payment Sources for Medications for Opioid Use Disorder? Evidence from Rhode Island

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  • Mary A. Burke
  • Riley Sullivan

Abstract

Using information from the all-payer claims database for Rhode Island covering more than three-quarters of health insurance enrollees in the state from April 2011 through May 2019, this paper offers new measures of the association between the Medicaid expansion and the rate of receipt of buprenorphine and methadone for opioid use disorder (OUD). These robust measures adjust for the extent to which new Medicaid payments for these medications that started in 2014 crowded out payments from either non-Medicaid insurance or from non-insurance subsidies for the treatment of opioid abuse. We find that crowding out was nontrivial but incomplete for either buprenorphine or methadone, such that the Medicaid expansion in Rhode Island appears to have enabled many patients to access medications for OUD for the first time. These findings offer support for the expansion of Medicaid in states that have not already done so.

Suggested Citation

  • Mary A. Burke & Riley Sullivan, 2022. "Did the Medicaid Expansion Crowd Out Other Payment Sources for Medications for Opioid Use Disorder? Evidence from Rhode Island," Current Policy Perspectives 93991, Federal Reserve Bank of Boston.
    • Handle: RePEc:fip:fedbcq:93991
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    References listed on IDEAS

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    1. Mary A. Burke & Katherine Grace Carman & Riley Sullivan & Hefei Wen & James Frank Wharam & Hao Yu, 2021. "Did the Affordable Care Act Affect Access to Medications for Opioid Use Disorder among the Already Insured? Evidence from the Rhode Island All-payer Claims Database," Working Papers 21-17, Federal Reserve Bank of Boston.
    2. Kosali Simon & Aparna Soni & John Cawley, 2016. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the 2014 ACA Medicaid Expansions," NBER Working Papers 22265, National Bureau of Economic Research, Inc.
    3. Akosa Antwi, Yaa & Moriya, Asako S. & Simon, Kosali I., 2015. "Access to health insurance and the use of inpatient medical care: Evidence from the Affordable Care Act young adult mandate," Journal of Health Economics, Elsevier, vol. 39(C), pages 171-187.
    4. Mary A. Burke & Riley Sullivan, 2020. "Medication-assisted Treatment for Opioid Use Disorder in Rhode Island: Who Gets Treatment, and Does Treatment Improve Health Outcomes?," New England Public Policy Center Research Report 20-3, Federal Reserve Bank of Boston.
    Full references (including those not matched with items on IDEAS)

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    More about this item

    Keywords

    opiod use disorder; Medicaid expansion; buprenorphine; methadone; crowding out; Rhode Island; all-payer claims database;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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