Abstract: Understanding Stakeholder Perspectives and the Implementation of Substance Use Disorder Services Under State-Level Health Policy Reforms (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Sunday, January 14, 2018: 9:45 AM

Independence BR B (ML 4) (Marriott Marquis Washington DC)

* noted as presenting author

Clifford Bersamira, AM, Doctoral Candidate, University of Chicago, Chicago, IL

Colleen Grogan, PhD, Professor, University of Chicago, Chicago, IL

Harold Pollack, PhD, Professor, University of Chicago, Chicago, IL

Amanda Abraham, PhD, Assistant Professor, University of Georgia, Athens, GA

Bikki Tran Smith, MA, MSW, Doctoral Student, University of Chicago, Chicago, IL

Christina Andrews, PhD, Assistant Professor, University of South Carolina, Columbia, SC

Peter Friedmann, MD, MPH, Professor, University of Massachusetts Medical School, Springfield, MA

Background and Purpose: The Affordable Care Act (ACA) has produced dramatic changes in the organization, funding, and accessibility of substance use disorder (SUD) treatment. As part of the National Drug Abuse Treatment System Survey (NDATSS) project to better understand the implications of the ACA and factors that influence state decision-making and actions regarding SUD service delivery reforms, we developed case studies of eight states through a series of in-depth qualitative interviews.

Methods: California, Colorado, Florida, Georgia, Kentucky, Ohio, New Hampshire, and New York were selected for inclusion based upon variation in: (1) Medicaid expansion versus non-expansion; (2) state-based versus federally-facilitated insurance exchange; and (3) salience of SUD issues, as measured by media attention. Approximately 10 stakeholders in each state involved in the implementation of state-level reforms including administrators from Single State Agencies for SUD Services, Medicaid, and Health Insurance Exchanges; regional and county behavioral health authorities; SUD service providers; treatment and recovery advocacy groups; and Managed Care and Qualified Health Plan representatives were interviewed via telephone, recorded, and transcribed. Using inter-coder reliability, a grounded theory and theme-based coding approach was conducted to identify dominant themes which were then analyzed alongside state policies and delivery model factors to understand emerging patterns.

Results: Several themes emerged from these interviews including: the opioid epidemic driving attempted state-level SUD policy and service delivery reforms; the necessity of strong leadership and experience as key ingredients for reform; and concerns about SUD provider readiness for administrative changes including Medicaid reimbursement. And while some states have clearly embraced the opportunity ACA afforded to reform their SUD service delivery system through Medicaid expansion and waiver opportunities, even states that have rejected ACA have attempted reforms to address the opioid epidemic. We detail the similarities and differences in state approaches toward reform.

Conclusions and Implications: Understanding how states are implementing SUD service delivery reforms provides important contextual information about the nature of health reform at the ground level and helps us to think about the motivations – including the opioid epidemic – and understandings of those responsible for policy planning and implementation.