Access to substance abuse treatment is a noted concern for people with disabilities. Although much is known about elders with dual eligibility for Medicaid and Medicare regarding any care utilization and expenditures, little is known about their younger counterparts and how substance abuse might contribute. Drawing on national Medicaid claims, treatment utilization was explored for adults with and without dual eligibility for Medicare. People with dual eligibility were less likely to both initiate and engage in treatment as compared to those without dual eligibility. Implications relate to how existing systems provide substance abuse treatment to people with disabilities.