New Study Shows Expansion of Medicaid Increases Alcohol Screenings and Highlights Need for Policies, Programs That Improve Patient Screenings

A new study, “Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough?” published in Alcohol: Clinical and Experimental Research, found that people living in U.S. states with expanded Medicaid access are more likely to receive alcohol screening during primary care checkups than people living in states that did not expand Medicaid access. The study also revealed the need for improvements in alcohol screenings for patients who do receive Medicaid – for example, comprehensive, evidence-based screenings or brief counseling.

Led by Aryn Phillips, PhD, an assistant professor at the University of Maryland’s School of Public Health and former predoctoral fellow at the Alcohol Research Group (ARG), a program of the Public Health Institute, the study is the first to examine whether the likelihood of receiving alcohol screening and brief counseling among nonelderly low-income adults is associated with living in states that expanded Medicaid eligibility under the Affordable Care Act. Study co-authors included Kate Karriker-Jaffe, PhD, at RTI International and other researchers.

The research team reviewed data from almost 16,000 low-income adults aged 18 to 64 living in 14 states that expanded Medicaid eligibility before 2017 and nine states that did not. The study found no significant associations between living in Medicaid expansion states and receipt of evidence-based interventions for alcohol misuse.

Findings suggest that expanded Medicaid access may increase screening rates through increased access to primary care. They also highlight the need for policies and programs that limit healthcare provider constraints and support healthcare providers in offering evidence-based screenings and counseling of alcohol use on a consistent basis.

Study researchers noted that the rates of receiving screening and counseling across this low-income sample were low. Only 60 percent of respondents were asked whether they drink and, of those who reported drinking within the last month, only half were asked how much they drank and a third were asked about binge drinking. Of people who reported drinking heavily, less than a third had been offered advice about risky drinking, and less than 20 percent received guidance on how to reduce or quit drinking.

The authors suggest that healthcare provider and system barriers, such as limited training, lack of tools for screening and referral, and time constraints, may be responsible for the low rates of screening and counseling.

“This research suggests that expanding access to medical care was key but it’s not enough.  It is critical that we address these barriers to care to ensure that people who may be at risk for alcohol-related health problems are identified and receive appropriate and effective support,” said Phillips.

The study “Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough?” by Aryn Phillips, Kate Karriker-Jaffe, Kara Bensley, Meenakshi Sabina Subbaraman, Joanne Delk, and Nina Mulia is a project of the Alcohol Research Group’s National Alcohol Research Center focused on the epidemiology of alcohol-related problems and disparities.

Support for this paper was provided by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (NIAAA) under award numbers P50AA005595 (Kerr, PI) and T32HL069771 (Carnethon, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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About the Alcohol Research Group
For over 60 years, the Alcohol Research Group (ARG) has been actively engaged in critically needed alcohol and other drug-related public health research. We study drinking and other drug use and how these and other factors such as gender, race/ethnicity, sexual identity, socioeconomic disparities, and environmental differences affect health. ARG is also home to the NIAAA-funded National Alcohol Research Center and training program. Please visit arg.org.

ARG is a program of the Public Health Institute, an independent nonprofit organization, dedicated to promoting health, well-being, and quality of life for people throughout California, across the nation and around the world. Please visit phi.org.

About RTI International
RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Clients rely on us to answer questions that demand an objective and multidisciplinary approach — one that integrates expertise across the social and laboratory sciences, engineering and international development. We believe in the promise of science, and we are inspired every day to deliver on that promise for the good of people, communities and businesses around the world. For more information, visit www.rti.org.