Substance-use treatment under Medicaid jumps, following expansion of program and increase in abuse of painkillers

Kentucky's expanded Medicaid program covered approximately 11,000 substance-use treatment services in the second quarter of 2016, a huge increase from the 1,500 services from January through March 2014, the first quarter that Medicaid was expanded under federal health reform.

So says a report from the Foundation for a Healthy Kentucky, which suggests that the expansion, "as well as other elements in the health law, have helped increase access to substance use treatment in the state," the foundation said in a press release. "But rising Kentucky rates of prescription opioid and heroin abuse are also likely to have played a role in the growth of several types of treatment for substance use."

The Patient Protection and Affordable Care Act "required most health insurance plans to cover substance use treatment . . . helping ensure that more people with drug and alcohol disorders have access to the treatment they need," said Ben Chandler, president and CEO of the foundation. "But expanded access to treatment is just one part of the solution to the growing problem of opioid abuse in Kentucky and across the nation."

The report, Substance Use and the ACA in Kentucky, is the latest from the foundation's continuing study of the reform law's impact in the state. "Kentucky was one of the earliest and hardest-hit states in the national opioid epidemic, and the report confirms that the problem continues to grow in the commonwealth, the release says.

"While overall inpatient admissions for substance-use treatment in 2015 (19,005) were down from 2005 (22,705), heroin and other opioids accounted for nearly half (46.2 percent) of those admissions in 2015, compared to just 11.6 percent in 2005." Also, "Doses of buprenorphine, a medication that doctors can prescribe as part of treatment for opioid addiction, rose from 2 million in the first quarter of 2013 to 3.5 million in the second quarter of 2016."

Prescriptions for hydrocodone, the most commonly prescribed painkiller, are declining in Kentucky, but the state has seen an increase in deaths related to heroin. The federal Centers for Disease Control and Prevention recently released data that showed heroin-related deaths in the nation were 20 percent more numerous in 2015 than in 2014.

"Research has found that people often progress from using prescription opioids to heroin because it provides stronger effects, is often less expensive than prescription opioids, and may sometimes be more readily available," the report says. "The move to heroin also may be a response to efforts to make prescription painkillers harder to obtain and abuse," the release says.

"Medicaid expansion has been particularly important to young adults, who have both the highest rates of substance use, as well as the highest rates of uninsurance," Chandler said. "Since the state expanded Medicaid coverage to those with incomes up to 138 percent of the poverty level, more than 100,000 Kentuckians ages 18 to 25 have gained coverage that includes substance-use treatment services." He noted that Gov. Matt Bevin's plan to reform Medicaid would keep the coverage.

A copy of the report is available here. Other reports from the foundation's study of Obamacare's impact in Kentucky are available here.