The Impact of Access to Substance Abuse Treatment on Disability

The paper provides a preliminary examination of whether changes in access to substance abuse treatment due to state Medicaid expansions from the Affordable Care Act (ACA) affected the number of disability beneficiaries. To do so, we use variation in the number of substance abuse treatment facilities accepting Medicaid as a form of payment over time and across counties, to identify the effect of changes in access to licensed substance abuse treatment facilities on disability claims in states that expanded Medicaid. We use a differences-in-differences estimation strategy to examine the impact of state Medicaid expansions by exploiting county level pre-expansion variation in the supply of substance abuse treatment facilities. Our specification uses within state variation in the pre-treatment supply of substance abuse treatment facilities among states that expanded Medicaid. Ultimately, our results suggest that state Medicaid expansions did not have a significant impact on the number of treatment facilities accepting Medicaid as a form of payment, and that access to substance abuse treatment did not have a significant impact on the number of disability beneficiaries. However, we do note that the number of treatment facilities declines disproportionately in counties that had a high pre-treatment supply of treatment facilities compared to counties with a low supply of treatment facilities.