{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T05:51:24Z","timestamp":1792734684020,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T00:00:00Z","timestamp":1720137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec><jats:label\/><jats:p>\n<jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>Policy Points<\/jats:title><\/jats:caption><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The adoption of Medicaid institutions for mental disease (IMD) exclusion waivers increases the likelihood of substance abuse treatment facilities offering mental health and substance abuse treatment for co\u2010occurring disorders, especially in residential facilities.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>There are differential responses to IMD waivers based on facility ownership. For\u2010profit substance abuse treatment facilities are responsive to the adoption of IMD substance use disorder waivers, whereas private not\u2010for\u2010profit and public entities are not.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The response of for\u2010profit facilities suggests that integration of substance abuse and mental health treatment for individuals in residential facilities may be cost\u2010effective.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:boxed-text><\/jats:p><\/jats:sec><jats:sec><jats:title>Context<\/jats:title><jats:p>Access to integrated care for those with co\u2010occurring mental health (MH) and substance use disorders (SUDs) has been limited because of an exclusion in Medicaid on paying for SUD care for those in institutions for mental disease (IMDs). Starting in 2015, the federal government encouraged states to pursue waivers of this exclusion, and by the end of 2020, 28 states had done so. It is unclear what impact these waivers have had on the availability of care for co\u2010occurring disorders and the characteristics of any facilities that expanded care because of them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from the National Survey of Substance Abuse Treatment Services, we estimate a two\u2010stage residual inclusion model including time\u2010 and state\u2010fixed effects to examine the effect of state IMD SUD waivers on the percentage of facilities offering co\u2010occurring MH and SUD treatment, overall and for residential facilities specifically. Separate analyses are conducted by facility ownership type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Results show that the adoption of an IMD SUD waiver is associated with 1.068 greater odds of that state having facilities offering co\u2010occurring MH and substance abuse (SA) treatment a year or more later. The adoption of a waiver increases the odds of a state's residential treatment facility offering co\u2010occurring MH and SA treatment by 1.129 a year or more later. Additionally, the results suggest 1.163 higher odds of offering co\u2010occurring MH\/SA treatment in private for\u2010profit SA facilities in states that adopt an IMD SUD waiver while suggesting no significant impact on offered services by private not\u2010for\u2010profit or public facilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study findings suggest that Medicaid IMD waivers are at least somewhat effective at impacting the population targeted by the policy. Importantly, we find that there are differential responses to these IMD waivers based on facility ownership, providing new evidence for the literature on the role of ownership in the provision of health care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1468-0009.12710","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T08:14:36Z","timestamp":1720167276000},"page":"669-691","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Impact of Medicaid Institutions for Mental Disease Exclusion Waivers on the Availability of Substance Abuse Treatment Services and the Varying Effect by Ownership Type"],"prefix":"10.1111","volume":"102","author":[{"given":"YIMIN","family":"GE","sequence":"first","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University"},{"name":"Sol Price School of Public Policy University of Southern California"},{"name":"Schaeffer Center for Health Policy and Economics University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JOHN A.","family":"ROMLEY","sequence":"additional","affiliation":[{"name":"Sol Price School of Public Policy University of Southern California"},{"name":"Schaeffer Center for Health Policy and Economics University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ROSALIE LICCARDO","family":"PACULA","sequence":"additional","affiliation":[{"name":"Sol Price School of Public Policy University of Southern California"},{"name":"Schaeffer Center for Health Policy and Economics University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,5]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Substance Abuse and Mental Health Services Administration.Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration;2022."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-02-22-6331"},{"key":"e_1_2_9_4_1","unstructured":"OwensPL HeslinKC FingarKR WeissAJ.Co\u2010Occurrence of Physical Health Conditions and Mental Health and Substance Use Conditions Among Adult Inpatient Stays 2010 Versus 2014. Agency for Healthcare Research and Quality;2018."},{"key":"e_1_2_9_5_1","volume-title":"Common Comorbidities With Substance Use Disorders Research Report","author":"National Institute on Drug Abuse","year":"2020"},{"key":"e_1_2_9_6_1","unstructured":"WachinoV.SMD # 15\u2010003 re: new service delivery opportunities for individuals with a substance use disorder. Centers for Medicare and Medicaid Services. July 27 2015. 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