The Impact of Access to Substance Use Disorder Treatment Facilities on Maternal and Infant Health

• In Event: From Taxes to Treatment: Policy Approaches to Substance Use and Maternal and Child Health

Abstract

Women in Kentucky experience maternal mortality rates substantially higher than the national average, with substance use disorder (SUD) identified as a major contributing factor. Substance use during pregnancy poses serious risks to both maternal and infant health, including neonatal abstinence syndrome (NAS), adverse birth outcomes, and postpartum complications. Despite the treatability of SUD, access to care remains uneven, particularly for pregnant individuals and Medicaid enrollees. This paper examines how changes in access to SUD treatment facilities affect infant and maternal health outcomes among Kentucky Medicaid recipients. 

In this paper, we exploit the staggered opening and closing of SUD treatment facilities across Kentucky from 2010 to 2019 as a series of natural experiments. Using comprehensive Medicaid claims data matched to detailed information on facility locations and services from the National Directories of Alcohol Abuse Treatment Facilities, we implement a difference‑in‑differences framework to estimate the causal effects of treatment access on infant and maternal outcomes. Our analysis focuses on geographic variation in physical access, as measured by facility presence within a zip code and distance to the nearest provider. We further distinguish facilities by key characteristics including acceptance of Medicaid and specialization in treating pregnant and postpartum women. 

We examine a range of outcomes for infants and mothers, including NAS diagnoses, birth outcomes, infant mortality, maternal SUD treatment utilization, and postpartum health indicators. Our findings indicate that increased access to SUD treatment significantly improves infant health when that access is tailored to pregnant women. Specifically, the opening of the first SUD facility specializing in the treatment of pregnant women within a zip code leads to a measurable reduction in the likelihood of NAS diagnoses among Medicaid-covered infants. In contrast, openings of facilities that do not specialize in pregnancy show little effect, highlighting the importance of service suitability in addition to physical proximity. 

Overall, our findings underscore the critical role of access to SUD treatment services in improving infant health outcomes. These results have important implications for Medicaid policy and efforts to address maternal and infant health disparities.

Author

• Beth Munnich, University of Louisville
  Presenting Author