Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018
Rashunda Lewis, Amy R. Baugher, Teresa Finlayson, Cyprian Wejnert, Catlainn Sionéan, National HIV Behavioral Surveillance (NHBS) Study Group, Pascale Wortley, Jeff Todd, David W. Melton, Colin Flynn, Danielle German, Monina Klevens, Rose Doherty, Conall O’Cleirigh, Antonio D. Jimenez, Thomas Clyde, Jonathon Poe, Margaret Vaaler, Jie Deng, Alia Al‐Tayyib, Daniel Shodell, Emily Higgins, Vivian Griffin, Corrine Sanger, Salma Khuwaja, Zaida Lopez, Paige Padgett, Ekow Kwa Sey, Yingbo Ma, Hugo Santacruz, Meredith Brantley, Christopher Mathews, Jack Marr, Emma Spencer, Willie Nixon, David W. Forrest, Bridget J. Anderson, Ashley Tate, Meaghan Abrego, William T. Robinson, Narquis Barak, Jeremy Beckford, Sarah Braunstein, Alexis Rivera, Sidney Carrillo, Abdel R. Ibrahim, Afework Wogayehu, Louis Moraga, Kathleen A. Brady, Jennifer Shinefeld, Chrysanthus Nnumolu, Timothy W. Menza, E. Roberto Orellana, Amisha Bhattari, Anna M. Flynn, Onika Chambers, Marisa Ramos, Willi McFarland, Jessica Lin, Desmond Miller, Sandra Miranda De León, Yadira Rolón-Colón, María Pabón Martínez, Tom Jaenicke, Sara N. Glick, Jennifer Kienzle, Brandie Smith, Toyah Reid, Jenevieve Opoku, Irene Kuo
Abstract
BACKGROUND: Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. METHODS: In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18-64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. RESULTS: Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0-2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3-1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1-1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4-0.7) than those in nonexpansion states. CONCLUSIONS: Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.