For treatment of substance use disorder, much research has focused on differences between Whites and African Americans in service access and use, but little has addressed disparities for Latinos, the fastest-growing population in the United States.
Scant attention has been given to Mexican Americans, the largest population of uninsured individuals and most critically underserved ethnic minority group in the United States. Given limited resources, Mexican Americans with substance-use disorder are more likely to seek treatment from publicly funded programs.
To better understand potential disparities in treatment of substance-use disorder for Mexican Americans, we analyzed data from the substance-use disorder treatment system in more than 100 publicly funded programs in Los Angeles County, California.
We found [Medicaid payment acceptance] to be the program characteristic most associated with successful treatment for Mexican American clients.
We compared data on non-Latino White and Mexican American patients from 2010, before the Affordable Care Act (ACA) and its Medicaid expansion was implemented, and 2013, after enactment of the ACA. We compared patients on demographics, drug use severity and mental health issues, and program characteristics, including acceptance of Medicaid payments.
Our three hypotheses were supported:
- Mexican Americans reported lower rates of treatment completion than non-Latino whites (13.3% vs 14.4%). Mexican Americans had significantly lower odds of successful treatment compared to non-Latino whites.
- Disparities in treatment were driven by differences in program and individual characteristics. Regarding individual characteristics, we found Mexican Americans being treated for methamphetamine, marijuana, or hashish use were more likely to successfully complete treatment compared to those using heroin. We also found that adjusting for days of drug use at program intake reduced disparities in successful treatment for Mexican Americans, although not all the factors we proposed were significant.
- Program acceptance of Medicaid payment significantly reduced treatment disparities for Mexican Americans compared to non-Latino whites.
The role of Medicaid in reducing disparities
Our research is, to our knowledge, the first effort to explore provider acceptance of Medicaid as a contributor to Latino treatment disparities. Not only did we find Medicaid payment acceptance reduced disparities, we found it to be the program characteristic most associated with successful treatment for Mexican American clients.
This suggests that these programs—which must undergo a licensing and regulatory process to receive such payments—were especially successful in helping Mexican Americans overcome barriers to successful treatment as Medicaid was expanding in California.
What issues will arise under the Trump administration considering these findings?
Given current debates regarding the principles of achieving universal health care and enhancing access to affordable and quality care, future research should explore how revised Medicaid coverage or other health insurance policies may affect the significant progress made in recent years in increasing health insurance coverage, as well as resulting access to specific programs such as those for substance use disorder.
In California, a new waiver program to be implemented this year (July) will support these goals regardless of potential federal changes. It will be critical for researchers to continue tracking progress in programs for the most vulnerable low-income and severely uninsured populations in California to inform national policy on improving health care for all.