Access To Services: Multiple Perspectives From Adults With Substance Abuse Disorders In Massachusetts

Abstract

This paper describes how 267 Massachusetts adult substance abuse consumers rated the substance abuse counseling they have received, their access to behavioral health care, and their overall experiences with their health plan or free care. This perspective is supplemented with information from administrative data on type of care received immediately after the baseline interview, including use of wraparound services while in treatment. We hypothesized that consumers in a carve-out behavioral health plan would view their care more favorably because they had a payment source for both substance abuse and mental health care. This hypothesis was confirmed. However, it is access to Medicaid insurance, not involvement of managed care, that is associated with greater access and higher consumer ratings of care.

Type of health insurance and the substance abuse treatment gap

“…Such Medicaid behavioral health coverage reforms in Massachusetts (Beinecke, Sheperd, Tetreault, Hodgkin, & Marckres, 2001) appeared to facilitate access, whereas access in Washington State remained problematic (Wickizer, Campbell, Krupski, & Stark, 2000). Among Massachusetts consumers who received SA counseling, access to Medicaid insurance was associated with greater access to care and higher consumer ratings of care (Larson, Zhang, Smith, & Kasten, 2005).…”