Medicaid Expansion and Substance Use-Associated Foster Care Entry Rates, 2010-2018

• In Event: Poster Session 03
  In Poster Session: PS 03 Topic - Social Policy

Abstract

Introduction: After years of declining foster care caseloads in the 2000s, the opioid epidemic has contributed to a rise in foster are admissions since 2012 (Meinhofer and Angleró-Díaz, 2019). Although the effects of the opioid epidemic are concentrated in rural areas of Appalachia, New England, and the Mountain West (Rigg, Monnat, and Chavez, 2018), less is known about the geographic distribution of substance use-associated foster care entries and whether they have increased in areas with high rates of opioid addiction and overdose deaths. One reason for these geographic disparities is access to health care, particularly drug treatment programs. For parents with substance use disorders, access to drug treatment may help them keep custody of their children. This treatment may be easier to access in states with an expanded Medicaid program (McCarty et al., 2019) and whose Medicaid programs cover medication-assisted treatments (MATs) for substance abuse. In this study, I examine how Medicaid expansion, generosity, and coverage of MATs are associated with substance use-associated foster care rates.
Method: I calculated rates of substance use-associated foster care rates by state and year using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the United States Census Bureau. AFCARS collects case-level information from states on all children in foster care, including reason for removal. Medicaid scores came from a report conducted by the Public Citizen Health Research Group (Ramírez de Arellano and Wolfe, 2007), who rated each state’s program on eligibility, services, care, and reimbursement. Data on Medicaid coverage of MATs came from a 2018 Substance Abuse and Mental Health Services Administration report. I used random-effects models with state and year fixed effects to predict each state’s substance use-associated foster care entry rate per year from 2010 to 2018.
Results: Figure 1 shows substantial geographic variation in rates of substance use-associated foster care entries by state; the highest rates were clustered in the Midwest and Appalachia. Table 1 presents the results from the random-effects models predicting substance use-associated foster care entry rates by state. Year fixed-effects (not shown) indicated that rates significantly increased over time. States who expanded Medicaid had on average 1.33 fewer entries per 10,000 children; in addition, a one standard deviation increase in the Medicaid score (indicating greater generosity) was associated with 1.57 fewer entries. Unexpectedly, Medicaid coverage of the buprenorphine implant and methadone was associated with 3.49 and 4.64, respectively, more substance use-associated foster care entries per 10,000 children.
Discussion: Rates of substance use-associated foster care entries vary considerably by state, ranging from fewer than one entry per 10,000 children in Louisiana to 69.28 entries per 10,000 children in West Virginia. These preliminary results suggest that Medicaid expansion and generosity are associated with lower rates. However, coverage of certain MATs was associated with higher rates. One explanation could be that accessing MATs brings parents into contact with mandatory reporters (McElrath, 2018). However, these results may simply reflect some other state characteristic associated with both coverage of these treatments and substance use-associated foster care entry rates.

Author

• Haley Stritzel, University of Texas at Austin
  Presenting Author