Amanda J. Abraham is with the School of Public and International Affairs, University of Georgia, Athens. Bikki Tran Smith, Colleen M. Grogan, and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Clifford S. Bersamira is with the Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu. Peter D. Friedmann is with the University of Massachusetts Medical School Baystate, Springfield.
Am J Public Health. 2019 Jun;109(6):885-891. doi: 10.2105/AJPH.2019.305052. Epub 2019 Apr 18.
To assess states' provision of technical assistance and allocation of block grants for treatment, prevention, and outreach after the expansion of health insurance coverage for addiction treatment in the United States under the Affordable Care Act (ACA). We used 2 waves of survey data collected from Single State Agencies in 2014 and 2017 as part of the National Drug Abuse Treatment System Survey. The percentage of states providing technical assistance for cross-sector collaboration and workforce development increased. States also shifted funds from outpatient to residential treatment services. However, resources for opioid use disorder medications changed little. Subanalyses indicated that technical assistance priorities and allocation of funds for treatment services differed between Medicaid expansion and nonexpansion states. The ACA's infusion of new public and private funds enabled states to reallocate funds to residential services, which are not as likely to be covered by health insurance. The limited allocation of block grant funds for effective opioid medications is concerning in light of the opioid crisis, especially in states that did not implement the ACA's Medicaid expansion.
评估美国平价医疗法案（ACA）扩大成瘾治疗医疗保险覆盖范围后，各州在治疗、预防和外展方面提供技术援助和分配整笔赠款的情况。我们使用了 2014 年和 2017 年作为国家药物滥用治疗系统调查一部分的单一州机构收集的两波调查数据。提供跨部门合作和劳动力发展技术援助的州的比例有所增加。各州还将资金从门诊治疗转移到住院治疗服务。然而，阿片类药物使用障碍药物的资源变化不大。亚分析表明，技术援助重点和治疗服务资金分配在医疗补助扩张和非扩张州之间存在差异。ACA 注入的新的公共和私人资金使各州能够将资金重新分配到住院服务，而这些服务不太可能被医疗保险所覆盖。考虑到阿片类药物危机，尤其是在没有实施 ACA 医疗补助扩张的州，将整笔赠款资金有限地分配用于有效的阿片类药物令人担忧。
