Four state policies introduced during the COVID-19 pandemic to spur telehealth expansion were associated with telehealth expansion by mental health facilities, but telehealth growth was lowest among facilities in counties with the largest percentage of black residents, according to a new RAND corporate study.
Telehealth expansion was also lower among facilities that accepted Medicaid or the Children’s Health Insurance Program, two government insurance programs that primarily help low-income Americans, according to the study.
Findings show that disparities in access to mental health care have persisted even as telehealth has expanded dramatically during the pandemic. The study is published in the journal JAMA network open.
Our findings show that state policies have an important role to play in expanding access to mental health, which could be lost if telehealth policies do not remain in place. Equally, disparities need to be addressed with targeted local legislation.”
Ryan McBain, lead author of the study and a policy researcher at RAND
RAND researchers sought to understand whether state-level policies were associated with the expansion of telehealth that occurred after the onset of the COVID-19 pandemic.
The study focused on four policies: equal payment for in-person and telehealth services among private insurers; authorization of audio-only telehealth services for Medicaid and Children’s Health Insurance Program (CHIP) enrollees; participation in the Interstate License Exchange Program, which allows psychiatrists to provide services across state lines; participation in the Psychology Interjurisdictional Compact, which allows clinical psychologists to provide services across state lines.
To understand the impact these policies have had on telehealth services at mental health facilities, researchers analyzed information gleaned from the Mental Health and Addiction Treatment Tracking Repository on more than 12,000 facilities. They have limited their focus to outpatient facilities, which play a huge role in telehealth.
Examining the period from April 2019 to September 2022, the study found that the percentage of mental health treatment facilities offering telehealth more than doubled during the period, from 39% to 88%.
During the study period, the number of states with equal pay legislation increased from six to 28 and the number of states with audio-only pay policies increased from 0 to 33. States that allow psychiatrists to practice beyond state lines increased from 28 to 38, while those allowing clinical psychologists to practice across state lines increased from seven to 32.
The researchers found that all four policies were significantly associated with a mental health treatment facility being more likely to offer telehealth services.
Mental health facilities in rural counties were more likely to offer telehealth than facilities in urban counties, while community mental health centers were more likely to offer telehealth than other types of facilities.
The percentage of black residents in a county was associated with a lower likelihood of a mental health facility offering telehealth. Compared with counties with 5% or fewer black residents, mental health facilities in counties with more than 20% black residents were 42% less likely to offer telehealth.
The researchers also found that mental health facilities that accepted Medicaid and CHIP were about 25 percent less likely to offer telehealth services. This is consistent with previous studies that have found that people enrolled in programs may have reduced access to outpatient care compared to people who have private insurance.
“While state policies appear to have helped the rapid increase in telehealth availability among mental health settings, a greater effort is needed to address the disparities to ensure all groups have equal access to care,” McBain said.
Support for the study was provided by the National Institute of Mental Health.
Other authors of the study are Megan S. Schuler, Nabeel Qureshi, Samantha Matthews, Aaron Kofner, Joshua Breslau and Jonathan H. Cantor.
RAND Health Care promotes healthier societies by improving health care systems in the United States and beyond.
McBain, R.K. et al. (2023) Expanding telehealth availability for mental health care after statewide policy changes from 2019 to 2022. JAMA network open. doi.org/10.1001/jamanetworkopen.2023.18045.
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