Defense Date


Document Type


Degree Name

Doctor of Philosophy


Healthcare Policy & Research

First Advisor

Andrew J. Barnes

Second Advisor

Peter J. Cunningham

Third Advisor

Robert L. Balster

Fourth Advisor

J. Randy Koch


Opioid-related overdoses increased dramatically in recent years. Medicaid plays a predominant role in paying for opioid use disorder (OUD) treatment. However, there is a critical gap in understanding the role of Medicaid coverage in referrals to treatment, treatment utilization, and treatment retention. The three studies used observational and quasi-experimental (i.e., natural experiment) designs leveraging state and year variation in Medicaid expansion to characterize the role of Medicaid coverage in OUD treatment. We found that individuals with OUD with Medicaid insurance were more likely to use outpatient treatment, whereas those who were uninsured were more likely to use self-help groups only. Medicaid expansion under the Affordable Care Act was positively associated with the likelihood of being referred to outpatient OUD treatment by healthcare providers. Medicaid expansion was also associated with longer durations of outpatient treatment among those also receiving medication for OUD. Amidst the current opioid epidemic, these findings emphasize the urgent need to continue to improve and expand Medicaid coverage for OUD treatment.


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Date of Submission