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

George Pro, Zach Giano, Ricky Camplain, Shane Haberstroh, Carly Camplain, Denna Wheeler, Randolph D. Hubach, Julie A. Baldwin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish
JournalCommunity Mental Health Journal
DOIs
StateAccepted/In press - 2020

Keywords

  • Health disparities
  • Health services
  • Mental health
  • Opioid use disorder

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