The opioid epidemic impacts all levels of society, yet discernible disparities exist concerning opioid use disorder (OUD) prevalence and access to treatment, including medications for opioid use disorder (MOUDs). Specifically, adults involved in the justice system face a disproportionate burden of OUD and are more likely to go untreated. Insurance coverage plays a critical role in facilitating healthcare access, including OUD treatment. Under the Affordable Care Act, select states elected to expand their Medicaid coverage to more low-income individuals. Additionally, some incarcerated individuals are affected by the "inmate exclusion" law which bars Medicaid from covering healthcare for those in correctional facilities. Some states automatically terminate Medicaid eligibility upon incarceration, while others choose to suspend. Although research indicates that Medicaid expansion correlates with increased insurance coverage and MOUD access and utilization within the general population, the effects on justice-involved individuals remain inadequately understood. To address these gaps, this dissertation examines the effects of state policies expanding access to Medicaid coverage on outcomes for individuals with OUD referred to treatment by the justice system using a quasi-experimental, difference-in-difference framework and data from the Treatment Episode Dataset-Admissions (TEDS-A) from 2006-2019. More specifically, we estimated the effects of Medicaid expansion on insurance coverage at admission (i.e., Medicaid, private, uninsured, or other) and planned utilization of MOUD for all justice referrals and the effects of suspension and Medicaid expansion on outcomes for individuals referred from prison or probation/parole since suspension policies should only affect recently incarcerated individuals. We found that Medicaid coverage increased while uninsurance decreased, and planned utilization of MOUD improved by 133%. Moreover, in expansion states, Medicaid coverage and planned utilization of MOUD increased. For the prison and parole/probation subpopulation, we found that Medicaid expansion improved Medicaid coverage and planned utilization of MOUD, but that Medicaid suspension was not associated with either outcome.


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Graduation Date





Atkins, Danielle


Doctor of Philosophy (Ph.D.)


College of Community Innovation and Education


School of Public Administration

Degree Program

Public Affairs; Health Services Management & Research


CFE0009683; DP0027790





Release Date

August 2024

Length of Campus-only Access

1 year

Access Status

Doctoral Dissertation (Campus-only Access)

Restricted to the UCF community until August 2024; it will then be open access.