According to a study published in JAMA Network Open, a reduction in deaths attributed to substance use disorders (SUD) can be associated with expansion of state Medicaid eligibility thresholds.
The investigators collected state-level data between 2002 and 2015, on Medicaid eligibility thresholds, defined as a percentage of the federal poverty level, and the number of SUD–related deaths from publicly available sources. The investigators performed a regression analysis using population-weighted fixed effects models and controlling for temporal trends, state socioeconomic characteristics, and other relevant state policies. State policies included controls related to mental health, overdose treatment, and law enforcement of drug crime. All policies, including the Medicaid eligibility threshold, were allowed a 1-year lag for associations to materialize.
Between 2002 and 2015, the number of deaths attributed to SUDs rose from 16.0 to 27.5 deaths per 100,000 population nationwide, while the average Medicaid eligibility threshold rose from 87.2% to 97.1% of the federal poverty level. In the study’s base-case sample, every 100-percentage-point increase in the Medicaid eligibility threshold was associated with 1.373 (95% CI, -2.732 to -0.014) fewer SUD–related deaths per 100,000 population for a total reduction of 6.50%.
Over the study period, 22 states had net decreases in Medicaid eligibility thresholds, which may have been associated with an estimated 570 (95% CI, -143 to 1283) SUD–related deaths that could otherwise have been prevented. In the 28 states with net increases in eligibility thresholds, the investigators estimated that 1045 (95% CI, -209 to 2299) SUD–related deaths may have been prevented.
Limitations to this study include the complexity of state Medicaid policies in which the study only captured 1 dimension (eligibility thresholds for parents), and the effects of coverage expansion could not be distinguished from other policy characteristics. Another limitation was the potential inaccuracy of coded data detailing the cause of death. Finally, because of the study’s observational design, a causal relationship may not be inferred between the associations.
The researchers suggest that a higher Medicaid eligibility threshold was associated with a reduction in deaths related to SUDs. Broader eligibility for Medicaid coverage may be a potential option to help reduce SUD–related deaths.
Disclosure: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.
Snider JT, Duncan ME, Gore MR, et al. Association between state Medicaid eligibility thresholds and deaths due to substance use disorders. JAMA Netw Open. 2019;2(4):e193056.