{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:05:16Z","timestamp":1777943116803,"version":"3.51.4"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>People experiencing homelessness (PEH) and individuals referred through the criminal-justice (CJ) system face high rates of substance use disorders (SUD) and persistent barriers to treatment. Although Medicaid expansion increased insurance coverage among low-income adults with SUD, it remains unclear how these reforms affected entry into publicly funded treatment for individuals experiencing both homelessness and justice involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 32.9 million specialty SUD treatment admissions reported to the Treatment Episode Data Set\u2013Admissions (TEDS) from 2006 to 2023. Multinomial logistic regression estimated demographic, socioeconomic, clinical, and insurance correlates across pathways. Comparative interrupted time series (CITS) models with state and year fixed effects assessed changes in admissions involving PEH\u2013CJ following Medicaid expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all admissions, PEH\u2013CJ admissions showed the highest levels of socioeconomic instability, repeated treatment episodes, and stimulant involvement. Multinomial models identified elevated relative risk among American Indian\/Alaska Native, Black, unemployed individuals, those with low educational attainment, and prior treatment episodes. CITS analyses showed no significant post-expansion change in PEH\u2013CJ admission probability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medicaid expansion did not alter reliance on publicly funded safety-net treatment for PEH-CJ. Continued dependence on the SUPTRS-BG highlights the need to align Medicaid reforms with strengthened safety-net financing and cross-sector support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag069","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T12:38:06Z","timestamp":1774096686000},"source":"Crossref","is-referenced-by-count":0,"title":["Homelessness, justice involvement, and publicly funded substance use treatment after Medicaid expansion"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0162-9380","authenticated-orcid":false,"given":"Suparna","family":"Das","sequence":"first","affiliation":[{"name":"Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7146-5783","authenticated-orcid":false,"given":"Kerry","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"2026050203162484700_qxag069-B1","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.drugalcdep.2018.04.021","article-title":"Substance use and homelessness among emergency department patients","volume":"188","author":"Doran","year":"2018","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"2026050203162484700_qxag069-B2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1080\/08897077.2018.1442899","article-title":"Socioeconomic and geographical disparities in prescription and illicit opioid-related overdose deaths in Orange County, California, from 2010\u20132014","volume":"40","author":"Marshall","year":"2019","journal-title":"Subst Abus"},{"key":"2026050203162484700_qxag069-B3","doi-asserted-by":"publisher","first-page":"112585","DOI":"10.1016\/j.socscimed.2019.112585","article-title":"Association between homelessness and opioid overdose and opioid-related hospital admissions\/emergency department visits","volume":"242","author":"Yamamoto","year":"2019","journal-title":"Soc Sci Med"},{"key":"2026050203162484700_qxag069-B4","doi-asserted-by":"publisher","first-page":"108717","DOI":"10.1016\/j.drugalcdep.2021.108717","article-title":"Opioid use disorder treatment for people experiencing homelessness: a scoping review","volume":"224","author":"McLaughlin","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"2026050203162484700_qxag069-B5","doi-asserted-by":"publisher","first-page":"e0254729","DOI":"10.1371\/journal.pone.0254729","article-title":"What treatment and services are effective for people who are homeless and use drugs? A systematic \u201creview of reviews\u201d","volume":"16","author":"Miler","year":"2021","journal-title":"PLoS One"},{"key":"2026050203162484700_qxag069-B6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12954-020-0356-9","article-title":"What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography","volume":"17","author":"Carver","year":"2020","journal-title":"Harm Reduct J."},{"key":"2026050203162484700_qxag069-B7","author":"SAMHSA","year":"2023"},{"issue":"1","key":"2026050203162484700_qxag069-B8","doi-asserted-by":"publisher","first-page":"e2142676","DOI":"10.1001\/jamanetworkopen.2021.42676","article-title":"Drug overdose mortality among people experiencing homelessness, 2003 to 2018","volume":"5","author":"Fine","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026050203162484700_qxag069-B9","doi-asserted-by":"publisher","first-page":"110910","DOI":"10.1016\/j.drugalcdep.2023.110910","article-title":"State-level homelessness and drug overdose mortality: evidence from US panel data","volume":"250","author":"Cano","year":"2023","journal-title":"Drug Alcohol Depend"},{"key":"2026050203162484700_qxag069-B10","doi-asserted-by":"publisher","first-page":"100174","DOI":"10.1016\/j.lana.2021.100174","article-title":"A longitudinal cross-sectional analysis of substance use treatment trends for individuals experiencing homelessness, criminal justice involvement, both, or neither\u2014United States, 2006-2018","volume":"7","author":"Shearer","year":"2022","journal-title":"Lancet Reg Health Am"},{"issue":"1","key":"2026050203162484700_qxag069-B11","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/ije\/dyw098","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2026050203162484700_qxag069-B12","author":"SAMHSA"},{"key":"2026050203162484700_qxag069-B13","author":"SAMHSA"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag069\/67493096\/qxag069.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/4\/qxag069\/67493096\/qxag069.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/4\/qxag069\/67493096\/qxag069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:16:30Z","timestamp":1777706190000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag069\/8539060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,2]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag069","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,24]]},"article-number":"qxag069"}}