Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use

JAMA Intern Med. 2020 May 1;180(5):753-759. doi: 10.1001/jamainternmed.2020.0473.


Importance: The rate of opioid-related emergency department (ED) visits and inpatient hospitalizations has increased rapidly in recent years. Medicaid expansions have the potential to reduce overall opioid-related hospital events by improving access to outpatient treatment for opioid use disorder.

Objective: To examine the association between Medicaid expansions and rates of opioid-related ED visits and inpatient hospitalizations.

Design, setting, and participants: A difference-in-differences observational design was used to compare changes in opioid-related hospital events in US nonfederal, nonrehabilitation hospitals in states that implemented Medicaid expansions between the first quarter of 2005 and the last quarter of 2017 with changes in nonexpansion states. All-payer ED and hospital discharges from 45 states in the Healthcare Cost and Utilization Project FastStats were included.

Exposures: State implementation of Medicaid expansions between 2005 and 2017.

Main outcomes and measures: Rates of all opioid-related ED visits and inpatient hospitalizations, measured as the quarterly numbers of treat-and-release ED discharges and hospital discharges related to opioid abuse, dependence, and overdose, per 100 000 state population.

Results: In the 46 states and District of Columbia included in the study, 1524 observations of emergency department data and 2219 observations of opioid-related inpatient hospitalizations were analyzed. The post-2014 Medicaid expansions were associated with a 9.74% (95% CI, -18.83% to -0.65%) reduction in the rate of opioid-related inpatient hospitalizations. There appeared to be no association between the pre-2014 or post-2014 Medicaid expansions and the rate of opioid-related ED visits (post-2014 Medicaid expansions, -3.98%; 95% CI, -14.69% to 6.72%; and pre-2014 Medicaid expansions, 1.02%; 95% CI, -5.25% to 7.28%).

Conclusions and relevance: Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use, possibly attributable to improved care for opioid use disorder in other settings.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Emergency Service, Hospital
  • Hospitalization*
  • Humans
  • Medicaid*
  • Medically Uninsured
  • Opioid-Related Disorders / therapy*
  • Patient Protection and Affordable Care Act*
  • United States


  • Analgesics, Opioid