PROJECT SUMMARY/ABSTRACT
While the opioid epidemic affects all levels of society, there are evident disparities in opioid use disorder
(OUD), as well as access to treatment for OUD, including medications for opioid use disorder (MOUDs). Adults
involved with the criminal justice system are disproportionately affected by OUD and are more likely to go
untreated for OUD. Insurance coverage is important for access to healthcare, including OUD treatment. Under
the Affordable Care Act (ACA), some states expanded access to Medicaid to cover more low-income
individuals, including childless adults. The majority of incarcerated individuals are low-income and uninsured
and are, therefore, likely to be Medicaid eligible. Additionally, access to Medicaid for some criminal justice
involved individuals is regulated by a federal law, commonly referred to as “inmate exclusion,” which prohibits
Medicaid from covering health services for those in a jail, prison, detention center, or other penal facility. Some
states terminate Medicaid for incarcerated individuals, while others suspend Medicaid coverage, which does
not require re-enrollment upon release. While research has shown that ACA Medicaid expansion is associated
with increased access to and utilization of MOUD in the overall population, little is known about the effects on
criminal justice involved individuals. Moreover, little is known about the effects of state Medicaid suspension
policies on OUD treatment outcomes in this population. To address this gap, my dissertation will use a
difference-in-difference framework to estimate the effect of Medicaid expansion and Medicaid suspension
policies on outcomes of interest using the Treatment Episode Datasets from 2000-2017. My aims are two-fold:
1) to describe OUD treatment outcomes for individuals referred to treatment by the criminal justice system over
time, by geography, and by Medicaid policy status; and 2) to estimate the effects of Medicaid expansion and
Medicaid suspension policies on treatment outcomes for criminal-justice referred admissions including: a) the
proportion of criminal justice referred admissions with OUD with Medicaid coverage, private insurance
coverage, and no insurance; b) the proportion of criminal justice referred admissions with OUD receiving
MOUD overall and by insurance status; and 3) the proportion of criminal justice referred admissions with OUD
completing treatment overall and by insurance status and MOUD utilization status. For each of these outcomes
of interest, I will also explore these relationships by subgroups to capture OUD severity (i.e., primary
substance, polysubstance use, intravenous drug use). Given the disproportionate OUD disease burden and
lack of access to care for criminal justice involved individuals, it is critical to understand what types of policy
interventions may be effective in addressing these disparities. This research will provide important and timely
information to support evidence-based policy- and decision-making to improve access to treatment for justice-
involved individuals.
