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The Affordable Care Act improved substance abuse service coverage and increased demand for these services. Presumably, these changes also influenced the number of substance abuse nonprofits in states. State decisions for Medicaid expansion have the potential to influence nonprofits' decisions to establish new facilities, increasing the demand for these services. In addition, Certificate of Need (CON), that is, state regulation of new health services and facilities, can affect nonprofits' responses to increased demand for substance abuse services. This study provides evidence that the number of nonprofit substance abuse facilities is negatively associated with state decisions to expand Medicaid and state regulation of new health services and facilities. However, in states with both Medicaid expansion and CON, the number of nonprofit substance abuse facilities tended to increase. In addition, evidence suggests that both nonprofit and for-profit substance abuse facilities are negatively influenced by Medicaid expansion and CON, but positively influenced by the interaction of Medicaid expansion and CON, government spending, racial diversity, median income, and uninsured rates.

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Factors Associated with the Number of Substance Abuse Nonprofits in the U.S. States: Focusing on Medicaid Expansion, Certificate of Need, and Ownership