Date of Award

Spring 1-1-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Busch, Susan

Abstract

This dissertation examines how state and federal policies shape the addiction treatment landscape, focusing on how the treatment delivery system responds to policy changes. Through three chapters, I evaluate policy tools designed to expand access to life-saving yet underutilized services and their potential to mitigate or reinforce disparities. The first two chapters analyze a Medicaid policy change that allowed states to access previously restricted funding, contingent on improving their addiction treatment systems. Chapter one finds that improvements in access and quality were primarily driven by facility turnover—new facility openings and closures—rather than changes within existing facilities. Chapter two assesses the geographic distribution of these improvements, showing that while access to Medicaid-accepting residential treatment facilities expanded broadly, quality improvements were concentrated in areas with fewer Black residents, highlighting persistent structural inequities. The third chapter evaluates the role of regulatory flexibility in expanding access to evidence-based addiction treatment services, focusing on provider responses to telehealth policy changes during the COVID-19 pandemic. Findings indicate that providers found telehealth more effective than expected and strongly supported keeping the temporarily loosened telehealth restrictions for opioid use disorder treatment. Together, these chapters provide new evidence on how financial and regulatory incentives shape provider behavior and market composition in addiction treatment. The findings underscore the need for carefully designed policies that not only expand access but also ensure equitable improvements in care quality. This research informs broader discussions on how Medicaid policy, payment incentives, and regulatory policy can be leveraged to promote equitable delivery of evidence-based addiction treatment.

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