MOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location

Area of Science:

• Public Health
• Health Services Research
• Substance Use Disorders

Background:

• Overdose death rates have disproportionately increased among Hispanic populations.
• Medication for opioid use disorder (MOUD) is an effective intervention but remains underutilized.
• State-level variations in insurance and behavioral health reforms following the Affordable Care Act (ACA) may impact MOUD access.

Purpose of the Study:

• To examine the increase in MOUD utilization after the ACA's implementation.
• To compare changes in MOUD use between Hispanic and non-Hispanic White individuals.
• To analyze MOUD use differences among Hispanic heritage groups and across states with varying Medicaid expansion statuses.

Main Methods:

• Analysis of ambulatory care episodes (TEDS-A, 2009-2019) for Hispanic and White individuals.
• Categorization of Hispanic clients by heritage group (Puerto Rican, Mexican, Other Hispanic).
• Grouping states by Medicaid expansion status and employing logistic regression and difference-in-differences analyses to compare MOUD use pre/post ACA.

Main Results:

• MOUD use among Hispanic clients was lowest in Non-Expansion States and highest in California.
• Post-ACA, only Puerto Rican and Other Hispanic heritage clients showed increased MOUD odds nationally.
• Hispanic and White clients exhibited similar MOUD use increases nationally and in Other Expansion States.

Conclusions:

• MOUD use among Hispanic clients increased following the ACA.
• Significant disparities in MOUD utilization persist among different Hispanic heritage groups and across states.
• Tailored strategies may be needed to address these remaining inequities in MOUD access.