Insurance Expansions and Children's Use of Substance Use Disorder Treatment

This study provides the first evidence on the effects of U.S. state-level private and public insurance expansions on specialty substance use disorder (SUD) treatment use among children ages 12 to 18. We examine both private and public expansions over the period 1996 to 2010. Public insurance expansions are measured by changes in income thresholds for Medicaid and the State Children’s Health Insurance Program (SCHIP). Private expansions are generated by state laws that compel private insurers to cover SUD treatment services at ‘parity’ with general healthcare services. We apply differences-in-differences regression models and leverage an all-payer admissions dataset. Our findings suggest that expansions, both private and public, lead to increases in admissions to treatment and increased insurance coverage among children in treatment. After public expansions, we find that treated children are more likely to be younger and to have previous experience with treatment, but less likely to be referred by the criminal justice system. We find no evidence that public expansions crowd out adult admissions, and in fact both public and private expansions increase at least some types of admissions among adults.