Medicaid Expansion Leads to Spike in Number of People Receiving SUD Treatment

The expansion of Medicaid has allowed thousands to receive treatment for substance use disorder (SUD), a new study shows.

States that chose to expand Medicaid following the enactment of the Affordable Care Act (ACA) have seen significantly more low-income adults seek treatment for SUD than states that did not. In fact, in four years, expansion states saw nearly 40% more people enter SUD treatment.

Those findings were published in the March edition of the journal Health Affairs.

“The ACA Medicaid expansion was designed to improve access to care for poor uninsured Americans and to reduce financial barriers to care,” the authors noted in the study. “Our study suggests that the expansion achieved both of these objectives for people who received care in specialty SUD treatment programs.”


For the study, researchers looked at a federal database containing information on specialty providers that from 2010 to 2017 either accepted public funding or were otherwise subject to state regulation. Over the time period, the database contained information for more than 11.2 million admissions.

The timeframe coincided with the 2010 passage of the ACA — which allowed for the expansion of Medicaid — and when those provisions officially began to take effect in 2014. In 2017, the last year for which researchers looked at data, President Trump announced his intentions to roll back the ACA in his first executive order issued in office.

Prior to expansion taking effect, there were no significant differences found in the number of SUD treatment admissions between states.


In the year following expansion, however, there were 123.4 more SUD treatment admissions per 100,000 nonelderly adults in states that expanded Medicaid than in states that didn’t expand Medicaid.

By the fourth year of the expansion, there were 283.2 more admissions per 100,000 nonelderly adults in Medicaid expanded states compared to their non-expanded counterparts, representing an increase of about 36%.

All states were given the option to expand their Medicaid programs under the ACA, with 25 states (plus the District of Columbia) initially choosing to do so. Presently, 37 states have expanded their Medicaid offerings.

Under Medicaid expansion, individuals whose incomes are less than 138% of the federal poverty level are eligible for Medicaid. Without Medicaid expansion, many of those people would not have access to insurance coverage.

According to the study, expansion states saw more increases across the board in terms of SUD treatments being sought. They had more people seeking general SUD treatment, medication-assisted treatment (MAT) for opioid use disorder (OUD) and treatment for alcohol misuse.

Overall, the share of SUD treatment admissions paid by Medicaid expanded states increased 23 percentage points compared to the non-expansion states.

Companies featured in this article: