The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid

TL;DR

This study shows that expanding Medicaid treatment policies in Virginia led to a gradual decrease in behavioral health hospital admissions compared to a neighboring state.

Contribution

The study provides evidence that expanding treatment coverage and Medicaid access reduces behavioral health inpatient admissions.

Findings

Behavioral health acute inpatient admissions in Virginia decreased by 2.6% in early 2018 following ARTS implementation.

The decrease intensified to 4.9% by late 2018 and further declined after Medicaid expansion in 2019.

Virginia's admission rates were consistently lower than North Carolina's after policy changes.

Abstract

We evaluated the impact of Medicaid policies in Virginia (VA), namely the Addiction and Recovery Treatment Services (ARTS) program and Medicaid expansion, on the number of behavioral health acute inpatient admissions from 2016 to 2019. We used Poisson fixed-effect event study regression and compared average proportional differences in admissions over three time periods: (1) prior to ARTS; (2) following ARTS but before Medicaid expansion; (3) post-Medicaid expansion. The number of behavioral health acute inpatient admissions decreased by 2.6% (95% CI [−5.1, −0.2]) in the first quarter of 2018 and this decrease gradually intensified by 4.9% (95% CI [−7.5, −2.4]) in the fourth quarter of 2018 compared to the second quarter of 2017 (beginning of ARTS) in VA relative to North Carolina (NC). Following the first quarter of 2019 (beginning of Medicaid expansion), decreases in VA admissions became larger relative to NC. The average proportional difference in admissions estimated a decrease of 2.7% (95% CI, [−4.1, −0.8]) after ARTS but before Medicaid expansion and a decrease of 2.9% (95% CI, [−6.1, 0.4]) post-Medicaid expansion compared to pre-ARTS in VA compared to NC. Behavioral health acute inpatient admissions in VA decreased following ARTS implementation, and the decrease became larger after Medicaid expansion.

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