Lawmakers have focused a great deal of attention on alleviating the opioid public health crisis, while at the same time addressing across-the-board concerns regarding affordability of healthcare. State level Medicaid expansion through the Affordable Care Act is one of those efforts, which targets low-income non-elderly adult populations, who tend to be more at risk of substance use disorders.
While Medicaid expansion has led to substantial increases in Medicaid reimbursement for substance use treatment, it has not specifically led to a detectable increase in hiring attempts to increase the substance use disorder and behavioral health treatment workforce, according to a study by Indiana University researchers.
"Effective treatment strategies exist and continue to improve for substance use disorder, but there are still severe hurdles in ensuring an adequate workforce in substance use disorder treatment," said Olga Scrivner, co-author of the study and research scientist at the Luddy School of Informatics, Computing, and Engineering. "While policies such as Medicaid expansion have increased access to treatment, it is still unclear whether such actions are large enough to expand the workforce in a robust way."
"A lack of an increased workforce means people in need of substance use disorder treatment are not receiving it," said Thuy Nguyen, another author of the study and postdoctoral researcher at the O’Neill School of Public and Environmental Affairs.
The study, published today in Plos One and part of IU's Responding to the Addiction Crisis Grand Challenge, examined hiring attempts in the substance use disorder and behavioral health treatment sector from 2010-2018. Using a novel database, Burning Glass Technologies, covering 174 million job ads — virtually all U.S. online job postings by employers — researchers compared U.S. job postings in this sector in Medicaid expansion and non-expansion states, testing for changes after expansion.
Nationally, researchers found little growth in job postings in the field — which for this study included outpatient, residential and hospital inpatient services in the substance use disorder and behavioral health treatment sector.
However, they detected some changes in the hiring landscape over the study period: a shift from registered nurses, psychiatric aides and surgeons to mental health counselors and assistants in outpatient and residential facilities, and from nursing assistants and human resources assistants to psychiatrics, sales managers and pharmacy technicians.
Overall, the five most frequent occupations that organizations attempted hiring in this sector were mental health counselors, registered nurses, medical and health service managers, psychiatric technicians, and clinical, counseling, and school psychologists. The highest spike in workforce needs was detected for mental health counselors during the years of 2016-2018.