Job postings in the substance use disorder treatment related sector during the first five years of Medicaid expansion

Background: Effective treatment strategies exist for substance use disorder (SUD), however severe hurdles remain in ensuring adequacy of the SUD treatment (SUDT) workforce as well as improving SUDT affordability, access and stigma. Although evidence shows recent increases in SUD medication access from expanding Medicaid availability under the Affordable Care Act, it is yet unknown whether these policies also led to a growth in hiring in the SUDT related workforce, partly due to poor data availability. Our study uses novel data to shed light on recent trends in a fast-evolving and policy-relevant labor market, and contributes to understanding data sources to track the SUDT related workforce and the effect of recent state healthcare policies on the supply side of this sector. Methods and data: We examine hiring attempts in the SUDT and related behavioral health sector over 2010-2018 to estimate the causal effect of the 2014-and-beyond state Medicaid expansions on these outcomes through “difference-in-difference” econometric models. We use Burning Glass Technologies (BGT) data covering virtually all U.S. job postings by employers. Findings: Nationally, we find little growth in the sector’s hiring attempts in 2010-2018 relative to the rest of the economy or to health care as a whole. However, this masks heterogeneity in the bimodal trend in SUDT job postings, with some increases in most years but a decrease in 2014 and in 2017, as well as a shift in emphasis between different occupational categories. Medicaid expansion, however, is not associated with any statistically significant change in overall hiring attempts in the SUDT related sector during this time period, although there is moderate evidence of increases among primary care physicians. Conclusions: Although hiring attempts in the SUDT related sector as measured by the number of job advertisements have not grown substantially over time, there was a shift in the hiring landscape. Many national factors including reimbursement policy may play a role in incentivizing demand for the SUDT related workforce, but our research does not show that recent state Medicaid expansion was one such statistically detectable factor. Future research is needed to understand how aggregate labor demand signals translate into actual increases in SUDT workforce and availability.