Impact of Medicaid Expansion on People Below the Poverty Line Who Inject Drugs

By Kelly Jordan

A new study led by researchers at Emory University’s Rollins School of Public Health and published in Addiction, looked at what impacts Medicaid expansion could have on people who inject drugs and are living below the federal poverty level.

Major findings include:

• People who inject drugs and live in a state with expanded Medicaid coverage were 19% more likely to get health insurance and were 9% less likely to report foregoing needed medical care because of its cost.
• Expanding Medicaid nationwide will save lives and improve community health.
• Expanded access to Medicaid did not, however, increase drug treatment participation rates among people in need of this care.

The larger story:

Drug overdose deaths are on the rise in the United States. Between 2001-2021, drug overdose deaths have gone up by more than five fold. People who inject drugs are at far higher risk of experiencing an overdose, because injecting delivers drugs more rapidly into the bloodstream, and injected drugs have higher potency.

How they conducted their research:

Researchers analyzed data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance collected in 2012, 2015, and 2018. They analyzed a sample of 19,946 people who inject drugs across 13 states that have expanded Medicaid and who fell at or below 138% of the federal poverty line (for states that have expanded Medicaid, those at this income level qualify for Medicaid based on income alone). About two-thirds of those included in this research had experienced homelessness in the last year and 41.6% reported an annual household income of less than $5,000.

What can be done:

• Medicaid expansion positively impacts access to health care among impoverished people who inject drugs, and can help end the overdose crisis and curb the spread of drug-related infections—including hepatitis C and HIV/AIDS.
• Additional policy and practice changes are needed to ensure that Medicaid expansion also increases rates of substance use disorder treatment participation.

Rollins authors on the study included Hannah Cooper, ScD, corresponding author; Stephanie Beane, PhD; Courtney Yarbrough, PhD; Regine Haardörfer, PhD; Umed Ibragimov, PhD; Sarah Landes; Snigdha Peddireddy; and Janet Cummings, PhD.