Evaluating the Statewide Effects of HIFA Waivers on Substance Use Disorder Treatment
In 2010, the Affordable Care Act (ACA) was signed into effect by former President Barack Obama. The act had the intention of expanding Medicaid and making healthcare more affordable and accessible for Americans by drastically overhauling previous U.S. healthcare regulation. Although the magnitude of the changes proposed by the ACA were one-of-a-kind, the concept of healthcare expansion was not unique to the ACA. Back in 2001, the Bush Administration gave states the ability to expand healthcare coverage on their own terms through the Health Insurance Flexibility and Accountability (HIFA) Demonstrative Initiative. The initiative allowed states to pay for their healthcare expansion by rolling back healthcare package benefits and increasing sharing costs. Using HIFA waivers, a total of four states implemented programs that expanded coverage to additional substance use disorder (SUD) susceptible populations. With this change, more people in these states now had health care coverage, which meant that in theory, more people had access to mental and behavioral health services. To determine whether these HIFA waivers have caused a significant change in the treatment rates for people with SUDs, estimates for states with HIFA waivers were compared to states without said waivers. These estimates were tracked from 2001 to 2008 through a fixed-effects model to determine whether there was a marked long-term difference associated with healthcare expansion through HIFA. According to these figures, there is evidence to suggest that the Bush Administration’s HIFA waivers had mixed effects on SUD treatment numbers depending on the admission type.
Health Insurance Flexibility and Accountability
Lee, Caroline (2020). Evaluating the Statewide Effects of HIFA Waivers on Substance Use Disorder Treatment. Undergraduate Research Scholars Program. Available electronically from