The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum

• Published in: Community mental health journal Vol. 57; no. 6; pp. 1017 - 1022
• Main Authors: Pro, George, Giano, Zach, Camplain, Ricky, Haberstroh, Shane, Camplain, Carly, Wheeler, Denna, Hubach, Randolph D., Baldwin, Julie A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2021; Springer Nature B.V
• Subjects: Community and Environmental Psychology; Community health care; Comorbidity; Drug addiction; Generalized linear models; Health problems; High risk; Integrated care; Linear analysis; Medicaid; Medical treatment; Medicine; Medicine & Public Health; Mental health; Mental health care; Mental health services; Methadone; Narcotics; Opioids; Original Paper; Polls & surveys; Psychiatry; Rural areas; Rural urban continuum; Rurality; Substance abuse; Substance abuse treatment; Treatment programs; Opioid use disorder; Health services; Mental health; Health disparities
• ISSN: 0010-3853; 1573-2789
• DOI: 10.1007/s10597-020-00719-z

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ( β =−0.038, SE = 0.005, p < 0.0001) than in expansion states ( β =−0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.