Influence of insurance type on healthcare utilization among rural people who use drugs.

Background: Insurance possession facilitates healthcare engagement. Though people who use drugs (PWUD) experience substantial health risks, a large proportion are un/underinsured. Medicaid/other insurance eligibility varies by state and criminal legal involvement (CLI), and a better understanding of their association is important to inform policy.

Methods: Participants in the Rural Opioid Initiative were recruited 2018-2020 across 10 states and completed surveys assessing their demographics and insurance status, CLI experiences, substance use-related healthcare utilization, and healthcare barriers and venues. Descriptive analyses examined these factors versus insurance status and were followed by multivariable regression to include Medicaid expansion state residence.

Results: The 2933 participants had a mean age of 36 years [s.d.= 10.3]; were 85 % White, 3.2 % Black, and 7.1 % Native American; and were 57.0 % men. Insurance status was categorized as none (23.9 %), Medicaid (60.0 %), and other (16.2 %). Reporting stop/search, arrest or jail correlated with a significant reduction in the proportion of persons with Medicaid insurance (all p < 0.001). Having ever received HCV/HIV screening, and eight types of substance use disorder treatment, were more common among Medicaid versus uninsured individuals (p ≤ 0.001). Medicaid insured individuals more frequently reported obtaining care at a private venue, and less frequently reported having no care (past 6-months) or care barriers (p < 0.001) CONCLUSION: Lack of insurance among rural PWUD was associated with CLI, reduced healthcare utilization, and greater care barriers. Medicaid coverage facilitates national-level guideline promulgation regarding healthcare access of individuals experiencing increased health risks. Links between Medicaid expansion and CLI indicate opportunities to better coordinate services.