Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City

Abstract

Objective: The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). Data Source: Medicaid claims and managed care plan enrollment files for 2015–2017 in NYC. Research Design: We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015–2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. Results: We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. Conclusions: Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.

Urgent need for substance use disorder research among understudied populations: examining the Asian-American experience

“…These challenges can be attributed to a cultural emphasis on self-reliance and a strong desire to maintain positive images and values regarding SUD and mental health. 9-11 Additionally, a significant percentage of Asian-American adults are foreign-born (71%), 8 and approximately one-third of Asian-American adults have limited English proficiency (LEP), 12 further complicating their access to appropriate substance use treatment services and interventions. Structural and system-level factors, including the lack of a bilingual and bicultural workforce, resources, and programs specifically tailored to meet the needs of Asian-American communities, play a significant role in perpetuating disparities in substance use treatment access.…”

“…This is, in part, due to the treatment or services not being culturally tailored, resulting from a lack of evidence-based treatment and strategies specifically designed for Asian-American populations. 9 Limited availability of treatment options in certain neighborhoods further exacerbates these disparities. 9 It is important to note that completion rates vary among Asian Americans based on factors such as state population, density, and social networks.…”

“… 9 Limited availability of treatment options in certain neighborhoods further exacerbates these disparities. 9 It is important to note that completion rates vary among Asian Americans based on factors such as state population, density, and social networks. 10 Methamphetamine and opiate users, particularly among Asian Americans, exhibit lower completion rates than alcohol users.…”

Improving DEIB in Addiction Medicine Training Through Interdisciplinary Collaboration and Program Evaluation

“…1,2 Differences in access to evidence-based care have been described for people of color, individuals who are economically disadvantaged, people with disabilities, and people who identify as lesbian, gay, bisexual, transgender, queer (LGBTQ+). [3][4][5] The Addiction Medicine (AM) workforce, a multidisciplinary community inclusive of many roles (e.g., medical providers, public health workers), seeks to help people living with SUDs achieve their recovery goals through healthcare, research, education, and advocacy. Clinical addiction providers care for patients who are diverse in age, gender, race, ethnicity, socioeconomic status, language, severity of disease, and medical and psychiatric comorbidities.…”

“…[10][11][12] Disparities in access to care and treatment outcomes for Black, Indigenous, and People of Color (BIPOC) populations have increased during the COVID-19 pandemic. 4,5,13 Non-Hispanic Black and Hispanic opioid overdose death rates increased from 2018 to 2020, while the number of overdose deaths declined among non-Hispanic White individuals. 3,14,15 In order to address and eliminate disparities in care, improved understanding of the needs of diverse communities and thoughtful workforce development and training in the AM field will be required.…”