The Impact of Medicaid Expansion on Rural/Urban Variations in Access to Substance Use Treatment
Substance abuse has become a major health problem in many of America’s rural communities. In addition to marijuana, methamphetamine, and cocaine, which have been cited as drugs of abuse in rural areas for several years, the misuse of prescription pain relievers has increased alarmingly in rural and urban areas over the past decade. Despite these increases in drug use, access to substance abuse treatment remains insufficient in many rural communities. The implementation of Medicaid expansion under the ACA could improve access to substance use treatment overall in the U.S., but it is not clear whether and to what extent the ACA Medicaid expansion will improve insurance coverage and access to substance use treatment in rural areas, especially in localities characterized by low levels of income and education. It is critical to understand how Medicaid expansions may impact these vulnerable groups that experience disproportionally high prevalence rates of substance abuse and a sizable unmet need for treatment.
This project’s primary objective is to examine the effects of Medicaid expansion on insurance coverage and access to substance abuse treatment across rural to urban areas as well as rural-urban differences in the policy effects. A secondary objective is to examine whether the effects of Medicaid expansion on coverage and access differ between rural areas with low and high socioeconomic status (SES) as well as between low-SES and high-SES rural residents with substance use disorders.