Single State Agencies, the ACA, and Sapt Block Grant Reallocation

Purpose: Insurance expansions created by the Affordable Care Act (ACA) will reduce the number of Americans without insurance coverage for addiction treatment by 30 million people. As a consequence, and especially in Medicaid expansion states, fewer people will require free or subsidized addiction treatment services financed by the Substance Abuse Prevention and Treatment (SAPT) block grant. These changes will allow Single State Agencies (SSAs), the state government agency that oversees publicly funded addiction treatment, new opportunities to reallocate SAPT block grant funds by shifting resources from treatment to other activities such as prevention and outreach. The purpose of the study is to examine whether SSAs intend to reallocate SAPT block grants funds due to ACA implementation, and if so, how they plan to reallocate funds. We examine differences across states according to whether they adopted the Medicaid expansion at this time.

Methods:Data are taken from the sixth (2013-14) wave of the National Drug Abuse Treatment System Survey (NDATSS). This study reports on nationally-representative data collected via internet-based surveys with SSA representatives about technical assistance and resources provided to addiction treatment providers in preparation for ACA implementation. Data were collected from 48 SSAs (47 states and DC), representing a 94% response rate. Descriptive statistics were calculated for states participating in Medicaid expansion (N=26).

Results: The majority of SSAs reported no anticipated changes in the allocation of SAPT block grants funds after implementation of ACA provisions in 2014. Seventy-two percent of SSAs reported no anticipated change in SAPT block grant funds allocation for prevention; 64.7% reported no anticipated change for treatment; 83.3% reported no anticipated change for outreach services; and 92.0% reported no anticipated change in administrative costs. However, a significantly higher percentage of states that are expanding Medicaid report anticipated changes in block grant fund allocations compared to states that are not. States expanding Medicaid are nearly four times as likely to report increasing block grant funds for prevention (38.5% vs 9.1%, p<0.05) and outreach services (57.7% vs 15.0%, p<0.01), and decreasing funds for addiction treatment (38.5% vs 9.1%, p<0.05).

Implications: States that are expanding Medicaid expect to make significant changes in their future allocation of SAPT block grant funds. SSAs in Medicaid expansion states view this expanded insurance coverage as representing a significant infusion of federal and state funds for substance abuse treatment, and, as a result, view these changes as an opportunity to increase focus on prevention and community-based outreach services. Consequently, people residing in Medicaid expansion may benefit from increased access to prevention and outreach services. Residents in non-expansion states will not garner the same benefits.