IU study looks at the effect of Medicaid expansion on the SUD treatment workforce

January 30, 2020

Lawmakers have focused a great deal of attention on alleviating the opioid public health crisis, while at the same time addressing across-the-board concerns regarding affordability of healthcare. State level Medicaid expansion through the Affordable Care Act is one of those efforts, which targets low-income non-elderly adult populations, who tend to be more at risk of substance use disorders.

While Medicaid expansion has led to substantial increases in Medicaid reimbursement for substance use treatment, it has not specifically led to a detectable increase in hiring attempts to increase the substance use disorder and behavioral health treatment workforce, according to a study by Indiana University researchers.

"Effective treatment strategies exist and continue to improve for substance use disorder, but there are still severe hurdles in ensuring an adequate workforce in substance use disorder treatment," said Olga Scrivner, co-author of the study and research scientist at the Luddy School of Informatics, Computing and Engineering. "While policies such as Medicaid expansion have increased access to treatment, it is still unclear whether such actions are large enough to expand the workforce in a robust way."

"A lack of an increased workforce means people in need of substance use disorder treatment are not receiving it," said Thuy Nguyen, another author of the study and post-doctoral researcher at the O'Neill School of Public and Environmental Affairs.

The study, published today in Plos One and part of IU's Responding to the Addiction Crisis Grand Challenge, examined hiring attempts in the substance use disorder and behavioral health treatment sector from 2010-2018. Using a novel database, Burning Glass Technologies, covering 174 million job ads -- virtually all U.S. online job postings by employers -- researchers compared U.S. job postings in this sector in Medicaid expansion and non-expansion states, testing for changes after expansion.

Nationally, researchers found little growth in job postings in the field -- which for this study included outpatient, residential and hospital inpatient services in the substance use disorder and behavioral health treatment sector.

However, they detected some changes in the hiring landscape over the study period: a shift from registered nurses, psychiatric aides and surgeons to mental health counselors and assistants in outpatient and residential facilities, and from nursing assistants and human resources assistants to psychiatrics, sales managers and pharmacy technicians.

Overall, the five most frequent occupations that organizations attempted hiring in this sector were mental health counselors, registered nurses, medical and health service managers, psychiatric technicians, and clinical, counseling, and school psychologists. The highest spike in workforce needs was detected for mental health counselors during the years of 2016-2018.

"The health care workforce has been growing tremendously in the recent decades," said co-author Kosali Simon, the Herman B Wells Endowed Professor at the O'Neill School of Public and Environmental Affairs. "Health care is now the nation's largest employer, surpassing retail and manufacturing. But there are still important deficits in the workforce, especially in behavioral health areas."

The team's next steps are to continue to look into the effect of policies, such as insurance reimbursement and scope of practice prescription laws, on the substance use disorder treatment workforce to better understand how policies affect workforce demand and contribute to creating a workforce that can meet the needs of people with substance use disorder.

"Understanding, managing and reducing substance use disorders requires expertise from different areas of research," said co-author Katy Börner, the Victor H. Yngve Distinguished Professor of Information Science at the Luddy School of Informatics, Computing and Engineering. "This project brings together students, faculty and industry experts who analyzed and visualized large-scale datasets to increase our understanding of the impact of policy changes on hiring practices related to substance use disorder treatment."
Other authors on the study were Esmé Middaugh, Luddy School of Informatics, Computing and Engineering and Bledi Taska, Burning Glass Technologies.

Responding to the Addictions Crisis

The Responding to the Addictions Crisis Grand Challenge initiative engages a broad array of IU's world-class faculty, as well as IU's business, nonprofit and government partners. Working together, the groups are contributing to an initiative to implement a comprehensive plan to reduce deaths from addiction, ease the burden of drug addiction on Hoosier communities and improve health and economic outcomes. This initiative is one of the nation's largest and most comprehensive state-based responses to the opioid addiction crisis -- and the largest led by a university.

Indiana University

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