Medicaid officials in 44 states (including the District of Columbia) responded to a KFF survey on policies and trends related to telehealth behavioral health service delivery. Officials have reported high rates of use of telehealth services for behavioral health purposes since the start of the pandemic and plan to continue the expansion of telehealth on a permanent basis.
Telehealth appears to be a necessity when accessing behavioral health services for Medicaid users.
In 2022, behavioral health, especially mental health, remained a top service category with high use of telehealth among Medicaid enrollees.
In a recent KFF survey, state Medicaid officials were asked about their telehealth delivery policies and trends when it came to behavioral health. Of all US states, only 44 participated (including the District of Columbia). The responses have led many to seek the permanent adoption of pandemic-era telehealth policy expansions.
At the start of the pandemic, all 50 states expanded coverage and/or access to telehealth services in Medicaid. Survey respondents said they have taken at least one specific Medicaid policy action to expand access to behavioral health care through telehealth. For example, states have expanded the types of behavioral health providers eligible to provide Medicaid services through telehealth. States have also expanded the categories of Medicaid behavioral health services eligible for telehealth delivery. Finally, states have recently allowed or expanded their audio-only services.
As of July 1, 2022, states were more likely to offer these audio-only services.
Audio-only coverage has been reported to help ease access to care, especially in rural areas with broadband access issues and for older populations who may have difficulty using audio-visual technology.
While many states have reported high use of telehealth for behavioral health care, some have noted usage trends among certain subgroups of Medicaid enrollees.
These trending subgroups include:
- Geographical: With states most commonly reporting particularly high telehealth usage for behavioral health in rural areas compared to urban areas.
- Demographic: These trends indicate that behavioral health conditions are more prevalent among young adults and whites. Notably, some states reported that younger enrollees (including children and non-elderly adults) were more likely to use telehealth for behavioral health care.
- Thunderstorm: States have frequently reported that the use of telehealth for behavioral health has declined since its peak at the start of the pandemic, but remains elevated since the pre-pandemic period. Future policy changes, such as to further expand or limit the flexibility of telehealth, could affect ongoing usage.
Nearly all responding states have seen some of these trends when tracking usage in 2022. Many expect to start doing so in 2023, which is important for the future of behavioral health Medicaid telehealth policy because it is based on a ‘continuous analysis of usage and other data, as well as federal guidance.
As states continue and expand their monitoring, the results of these analyzes can provide insights that can inform policy decisions.
For example, the Bipartisan Safer Communities Act, signed in June 2022, directs CMS to provide guidance to states on options and best practices for expanding access to telehealth in Medicaid, including strategies for assessing the impact of telehealth on quality and on the results, KFF said. CMS must therefore issue this guidance by the end of 2023.
The Consolidated Provisions Act passed in December 2022 authorized additional telehealth provisions, such as requirements for Medicaid provider directories to include telehealth coverage information and for CMS to provide guidance on how states can use telehealth to provide telehealth services. crisis response.