Treatment Completion Among African Americans Living in States That Have Expanded Medicaid

Background and Purpose: Variations in Medicaid policies at the state level and individual factors that affect the completion of treatment for mental health and substance abuse disorders among African American adults present a significant challenge, limiting equitable access to services and resulting in adverse health outcomes¹. Existing studies have shown less than half of African American individuals with alcohol use disorders who qualified for Medicaid based on new federal guidelines were living in states that had expanded Medicaid². Additionally, there are disparities in access to Medicaid for African American individuals with drug use disorders. The purpose of the following study is to examine factors associated with treatment completion among African American participants living in states that have expanded Medicaid programs.

Methods: Binomial logistic regression modelling was employed to evaluate associations between mental health, substance use disorders, and treatment completion among a sample of African American participants living in states with expanded Medicaid. Data for this study was collected from the 2021Treatment Episode Discharge (TEDS-D). The analytic sample included (n=56,405) adult participants. The sample was comprised of slightly more male (71%) than female (28%) participants. Based on the survey, data were elicited on sociodemographic, insurance status, past-year mental health treatment (both inpatient and outpatient treatment utilization), and past-year substance use treatment utilization.

Results: Overall results from this analysis indicated that sex, having health insurance, and diagnosis with either mental health or substance use disorders were significantly associated with completing treatment. Male participants had higher odds of completing treatment compared to female participants (OR: 1.38, 95 % CI: 1.32-1.44). Participants who reported having other types of insurance were less likely to complete treatment compared to those who had private insurance. Participants with a mental health diagnosis had lower odds of completing treatment compared to participants diagnosed with a SUD (OR: 0.62, 95 % CI: 0.58-0.67). Additionally, participants who reported having co-occurring mental and SUDs, had 53%lower odds of completing treatment (OR: 0.47, 95 % CI: 0.45-0.48) than individuals without co-occurring disorders. Furthermore, participants with no prior substance use treatment were more likely to complete treatment compared to those with no history of treatment (OR: 1.41, 95 % CI: 1.36-1.46).

Conclusions and Implications: The results of this study indicate that several factors, such as possessing health insurance, co-occurring mental health and substance misuse disorders, and sex play a role in the completion of treatment among African American adults residing in states with expanded Medicaid. Additionally, the findings suggest that African American individuals were less inclined to express a need for behavioral health treatment and to have health insurance, potentially leading to a reduced likelihood of utilizing behavioral health care services. This research contributes valuable insights into the correlation between health insurance coverage and treatment adherence among African American adults in states with expanded Medicaid programs. Furthermore, it highlights the importance of treatment that can address both mental health and substance misuse issues to ensure treatment completion and success among individuals with co-occurring disorders.