The quality of addiction treatment in persistent poverty counties versus non-persistent poverty counties: the role of Medicaid

<i>Background:</i> Substance use disorders are more prevalent in areas of extreme poverty. Few studies have evaluated the differences in quality of addiction treatment associated with persistent poverty status (counties where at least 20% of residents have been in poverty for 20 years or more) and Medicaid access. <i>Objective:</i> This study aims to (1) investigate whether there is a difference in the quality of addiction treatment between counties identified as persistent poverty counties and those not and (2) determine the effect of Medicaid expansion on quality. <i>Methods:</i> We analyzed data from the National Substance Use and Mental Health Services Survey and the US Census American Community Survey. We performed fixed and random effects regression analysis to determine the likelihood of access to high-quality care, including evidence-based behavioral health services, medications for addiction, staff accreditation, medical treatment, recovery services, increased access to treatment, personalized-treatment plans, and long-term services. <i>Results:</i> Adjusted regression results revealed that persistent poverty county status was associated with a higher likelihood of access to high-quality care in states that expanded Medicaid (OR = 1.37, 95% CI 1.10, 1.70). Persistent poverty counties were also more likely to provide medical services, rapid access to treatment, and personalized treatment plans. However, only access to medical services remained significant in the unadjusted model in states that did not expand Medicaid (OR = 2.10, 95% CI 1.03, 4.30). <i>Conclusions:</i> Substance treatment providers in persistent poverty counties were more likely to provide higher quality care, but Medicaid expansion played an important role. Implications for substance treatment policy and practitioners are discussed.