Influence of State Medicaid Section 1115 Waivers on Adolescent and Young Adult Substance Use Disorder Screening and Treatment

The National Survey on Drug Use and Health points to a widespread increase of substance use disorder (SUD) among adolescent and young adults between the ages of 12 and 20. The prevalence of SUD among this population doubled from 6.8% in 2018 to 13.4% in 2022, affecting nearly 5.2 million young adults. The risk of SUD also increased among youths in foster care whose parents have a history of substance use and were removed from home. As Medicaid is the largest single-payer health plan to finance SUD treatment, Medicaid policies such as Section 1115 waivers provide the opportunity for states to increase the availability of services offered at residential SUD and mental health treatment facilities and tailor treatment needs for young adults.

This pilot study will be the first to examine the association between Section 1115 waiver youth provisions and SUD treatment utilization among youths and those in the foster care system. Using the Transformed Medicaid Statistical Information System Analytics Files, Sarah Gutkind will also evaluate the implementation of a Section 1115 waiver in West Virginia, a state that expanded coverage across the SUD care continuum for youth in foster care. Findings from this study can inform state policy makers who seek to submit, renew, or amend behavioral health-related Section 1115 waivers to improve SUD screening and treatment among youth insured by Medicaid.

Sarah Gutkind is entering her second year as a postdoctoral associate in the Division of Health Policy and Economics of the Department of Population Health Sciences at Weill Cornell Medicine. She earned her PhD in epidemiology at Columbia University Mailman School of Public Health. Her research there focused on predictors of substance use disorder and on social policies that could affect substance use and treatment. Her dissertation examined whether financial strain was associated with substance use and whether the Earned Income Tax Credit could mitigate financial strain and alter substance use. Gutkind’s current research focuses on understanding the association between medical cannabis laws and Medicaid policies on substance use outcomes and substance use disorder treatment utilization.