­­Access to Health Insurance and Treatment Utilization for Opioid Use Disorder: Evidence From State Medicaid Expansions

Background. Medicaid is a major payer of substance use disorder treatment, yet the impact of Medicaid expansion on the opioid epidemic has not been sufficiently quantified. This study exploits state-level differences in Medicaid expansion to assess the impact of access to health insurance on treatment utilization for opioid use disorder (OUD) for adults in need.Method. We use admissions data from Treatment Episode Data Sets (TEDS) to fit a multivariate difference-in-difference model, with non-expanding states as controls, adjusting for age, gender, race/ethnicity, education, and other state-level factors. Results. Medicaid expansion led to substantial gain in OUD treatment utilization. Admissions for substance use disorder among Medicaid beneficiaries increased by 20-33 percentage points in expansion states. Admissions were significantly higher for the newly eligible Medicaid beneficiaries in the 30-34 age group. We also see an increase in treatment admissions for opioid and heroin use among the elderly over the age of 55. Uninsurance rates show a commensurate decline in the expansion states. Finally, we do not find strong evidence of crowding-out of private insurance. Conclusions. Overall, our findings suggest that Medicaid expansions had a positive impact on the financing and utilization of opioid use treatment.

Chronic Disease Among Medicaid Beneficiaries Over 50: The Potential Impact of Medicaid Work Requirements

Since 2018, several states have proposed requiring work or other community engagement activities as a condition of receiving Medicaid; however, there has been little inquiry into the impact of such policies on Medicaid recipients over 50. Here, we describe the prevalence and burden of chronic disease among Medicaid beneficiaries over 50 who might be impacted by Medicaid work requirements. We used data from the 2016 wave of the Health and Retirement Study, a large-scale population-based study of adults aged >50. Our sample included individuals over 50 who were not Medicare-eligible (<65 years old) and not receiving Social Security Income. We used logistic regression models to compare those working <20 hours per week (the minimal community engagement/work cutoff) to those working >=20 hours per week, adjusting for age, race/ethnicity, sex, education, and marital status. Individuals working <20 hours per week had greater prevalence of chronic health conditions, including greater odds of diabetes (OR: 2.06; 95% CI: 1.37-2.46), hypertension (OR:2.56; 95% CI: 1.69-3.89), arthritis (OR: 2.96; 95% CI: 2.06-4.62, and lung disease (OR: 4.11; 95% CI: 2.31-7.32). Further, among those with chronic health conditions, those working <20 hours per week reported more, medication use, more worsening of their conditions in the past 2 years, and more hospitalization than their counterparts. Taken together, these finding suggest that Medicaid work requirements in this population would have the most impact on the most medically vulnerable individuals. Policymakers should consider this as they propose policies impacting Medicaid coverage in this population.

Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory

Background: Osteoarthritis is the most common chronic disease among elders, and it crucially requires self-management. This study aimed to qualitatively examine exercise experiences of elderly Medicaid beneficiaries with osteoarthritis receiving exercise intervention based on self-determination theory (SDT).Methods: Eight elders who received a community-based exercise intervention were interviewed three times. Using the interview transcriptions and field notes, researchers conducted an interpretative phenomenological analysis based on SDT to explore the motivational process of exercise compliance.Results: Three meaningful profiles (non-compliant, intermitter, and compliant) were identified along with satisfaction with needs (autonomy, competence, and relatedness) that motivate exercise compliance based on SDT. Compliance of exercise is primarily initiated by external regulation and followed by the internalization process of recognizing and accepting the value of the behavior.Conclusions: The concepts of SDT could be used to explore factors associated with motivation and gradual behavior change among elderly Medicaid beneficiaries with osteoarthritis. Autonomy, competence, relatedness, external regulation, and identified regulation control may be applied to establish a strategy that promotes behavior change by satisfying the psychological needs and internalizing the behavior of these elders.