Influence of insurance type on healthcare utilization among rural people who use drugs

Insurance possession facilitates healthcare engagement. Though people who use drugs (PWUD) experience substantial health risks, a large proportion are un/underinsured. Medicaid/other insurance eligibility varies by state and criminal legal involvement (CLI), and a better understanding of their association is important to inform policy.

Participants in the Rural Opioid Initiative were recruited 2018-2020 across 10 states and completed surveys assessing their demographics and insurance status, CLI experiences, substance use-related healthcare utilization, and healthcare barriers and venues. Descriptive analyses examined these factors versus insurance status and were followed by multivariable regression to include Medicaid expansion state residence.

The 2933 participants had a mean age of 36 years [s.d.= 10.3]; were 85 % White, 3.2 % Black, and 7.1 % Native American; and were 57.0 % men. Insurance status was categorized as none (23.9 %), Medicaid (60.0 %), and other (16.2 %). Reporting stop/search, arrest or jail correlated with a significant reduction in the proportion of persons with Medicaid insurance (all p < 0.001). Having ever received HCV/HIV screening, and eight types of substance use disorder treatment, were more common among Medicaid versus uninsured individuals (p ≤ 0.001). Medicaid insured individuals more frequently reported obtaining care at a private venue, and less frequently reported having no care (past 6-months) or care barriers (p < 0.001) CONCLUSION: Lack of insurance among rural PWUD was associated with CLI, reduced healthcare utilization, and greater care barriers. Medicaid coverage facilitates national-level guideline promulgation regarding healthcare access of individuals experiencing increased health risks. Links between Medicaid expansion and CLI indicate opportunities to better coordinate services.