Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018

Abstract

Background Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. Methods In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18–64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. Results Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0–2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3–1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1–1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4–0.7) than those in nonexpansion states. Conclusions Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.

Association of co-occurring mental health problems with hepatitis C status among young people who inject drugs in rural New Mexico, 2016–2018

“…Notably, a high proportion of our participants (91.9%) had insurance, and 76% of the total sample was on Medicaid. This is a similar proportion to that seen in analysis of healthcare insurance status among PWID in urban settings across the USA in 2018, which found that in Medicaid expansion states, 71% had Medicaid coverage (vs 14% in non-Medicaid expansion states) [ 50 ]. New Mexico implemented expanded Medicaid in 2014, before our study period, and it is encouraging to see the reach of this expanded access to rural counties.…”

Understanding healthcare engagement for people who inject drugs

“…Many studies have confirmed this finding, demonstrating a positive association between health insurance and health engagement (Barocas et al, 2014; Hoots et al, 2017). One study in particular demonstrated that PWID in states that expanded Medicaid were significantly more likely to have health insurance, a usual source of healthcare, and access to MOUD compared with those in nonexpansion states (Lewis et al, 2020). Healthcare access, particularly expanded Medicaid though the Affordable Care and Patient Protection Act, remains an important provision for healthcare engagement for PWID.…”

Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review

“…These findings suggest that linkage to healthcare insurance could be more salient to healthcare engagement with the expansion of health insurance. One recent study found that PWID in Medicaid expansion states was more likely to have insurance (aPR 2.3; 95% CI 2.0–2.6) and have a usual source of healthcare (aPR 1.5; 95% CI 1.3–1.9) (Lewis et al, 2020) than PWID in non‐expansion states. This study was not included in our analysis due to the authors' definition of PWID including individuals reporting non‐injection opioid use.…”