State Policy and Geography

Rates of facilities offering non-English language services per 1,000 limited English-speaking households varied widely across states. Some states had relatively low rates despite high limited-English-speaking household shares and above-average SUD prevalence. The finding of higher odds in Medicaid non-expansion states should not be interpreted as proof that Medicaid expansion reduces access. The study included state-level covariates such as cultural competency training requirements, limited English-speaking households, SUD prevalence, rurality, income inequality, region, political orientation, and Medicaid expansion status. Federal language-access policy changes may affect culturally and linguistically appropriate SUD services.