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

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 the changes in the nature of hiring in 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 the current SUDT related workforce and the effect of Medicaid expansion on hiring attempts in this sector. We examine attempts over 2010-2018 at hiring in the SUDT and related behavioral health sector as background for estimating the causal effect of the 2014-and-beyond state Medicaid expansion 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. 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 diverging trends in subsectors, which saw reduction in hospital based hiring attempts, increases towards outpatient facilities, and changes in occupational hiring demand shifting from medical personnel towards counselors and social workers. Although Medicaid expansion did not lead to any statistically significant or meaningful change in overall hiring attempts, there was a shift in the hiring landscape.