Year of Publication



Martin School of Public Policy and Administration

Date Available


Degree Name

Master of Public Administration

Committee Chair

Dr. Merl Hackbart

Executive Summary

This paper provides a contextual review of research investigating associations between the health insurance reforms implemented by the Affordable Care Act and the accessibility and utilization of medication-assisted treatment for opioid use disorder. Research indicates that relative to 2008, the year of initial Medicaid expansions in 2014 is nationally associated with increased rates of insurance coverage, increased rates of treatment, and reduced rates of individuals with opioid use disorder forgoing treatment due to financial concerns (McKenna 2017). Between the year prior to state Medicaid expansion and the third year after it, the number of specialty treatment admissions related to the medication-assisted treatment of opioid use disorder increased across all payers by a significantly larger amount than in nonexpansion states (Saloner, Levin, et al. 2018). The proportion of outpatient admissions who received methadone or buprenorphine for opioid use disorder increased across all payers by over eleven percentage points in expansion states and by under one percentage point in nonexpansion states between the 2010-2013 period and 2014-2016 (Mojtabai, et al. 2019). In addition, provisions within the Affordable Care Act support an opportunity to integrate medication-assisted treatment with the mainstream healthcare system which could result in improved outcomes for individuals receiving treatment (Substance Abuse and Mental Health Services Administration 2018b). While evidence shows improvements in the access and utilization of treatment, some states have not expanded Medicaid while others do not cover or impose restrictions on methadone (KFF 2018d). Other existing concerns include questionable compliance with parity law in private providers (Tovino 2019), nonexpansion low-income populations in the “coverage gap” (KFF 2020c), and a Supreme Court case challenging the Affordable Care Act’s constitutionality (Musumeci 2020).



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