Eliminating then (sort of) restoring substance abuse and mental health benefits in the oregon plan: Effects on treatment for most vulnerable medicaid clients

Cutbacks may differentially affect sub-groups within the Medicaid population. This chapter summarizes 2005 survey data from Oregon Health Plan members including both traditional Medicaid and expansion population clients. The statewide sample was augmented by clients currently in substance abuse treatment who had been Medicaid beneficiaries prior to the 2003 benefit cuts. Among those who had experienced or expressed need for substance abuse or mental health treatment there was no apparent decline in access to behavioral health care for either expansion or traditional Medicaid clients following benefit elimination in 2003. There was also no increase in access following restoration of the benefit in 2004. Clients who were receiving substance abuse or mental health treatment prior to the elimination of these benefits were significantly more likely to maintain access to care following the policy changes than were those who were in need but were not already in treatment prior to the policy change. These results are in marked contrast to the overall declines in behavioral health treatment shown by Oregon Medicaid population data as well as the decreases for Oregon methadone maintenance clients reported in previous chapters. On the other hand, the Oregon data reported here echo findings from California in an early chapter suggesting that at least some Medicaid clients in substance abuse treatment are able to continue care even in the absence of insurance coverage. An important message is that Medicaid policy changes can have assorted and widespread impacts.