Medicaid Telehealth has emerged as a crucial component in extending and facilitating access for individuals with behavioral health needs. The COVID-19 pandemic has highlighted the importance of telehealth to deliver healthcare services safely and effectively. A recent survey conducted by the Kaiser Family Foundation (KFF), which surveyed state Medicaid officials across 44 states in the US, including the District of Columbia, revealed an increased interest in permanently adopting pandemic-era telehealth policy expansions.
The survey results showed that behavioral health, particularly mental health, remained a top service category in the state fiscal year (FY) 2022. This is supported by data from the Centers for Medicare and Medicaid Services (CMS), which confirms the increased access and utilization of behavioral health services during the pandemic. This increase in telehealth utilization led to an uptick in outpatient Medicaid visits for behavioral health services. However, the pandemic also brought a decline in in-person utilization of mental health outpatient services, highlighting the ongoing need for telehealth as a viable alternative.
The survey demonstrates the importance of telehealth for Medicaid to improve access to behavioral health services for individuals enrolled in Medicaid. The findings indicate that many states are seeking permanent adoption of telehealth policy expansions, which have the potential to improve access to behavioral health services and reduce healthcare disparities for vulnerable populations.
The KFF’s Behavioral Health Survey Of Medicaid Telehealth Programs Asked The Following Questions
To gain a deeper understanding of the trends and policies surrounding the delivery of behavioral health services via telehealth, the survey sought to answer the following key questions:
- What measures have states implemented to extend telehealth coverage for behavioral health care during the COVID-19 pandemic?
- What have been the observed trends in utilizing telehealth services for behavioral health among states?
- What are the significant concerns to consider in the future of telehealth delivery for behavioral health within Medicaid programs?
Survey Result: Behavioral Health Medicaid Telehealth Policy In Response To COVID-19
The survey also gathers information on the specific actions taken by states to expand telehealth for behavioral health services under Medicaid in response to the COVID-19 pandemic. The survey sought to determine any changes that have been implemented or are planned to be implemented in these policies. The outcome of the study revealed the following results:
- Audio-only coverage of behavioral health services was the most common Medicaid policy action taken to expand access to behavioral health care via telehealth
- Nearly all states reported expanding behavioral health services allowed to be delivered via telehealth
- Many states noted that virtually all behavioral health services were eligible for telehealth delivery during the pandemic
- Most states reported expanding the provider types that may be reimbursed for telehealth delivery of behavioral health services
- A few states noted additional behavioral health Medicaid policy actions beyond those specified
- Washington reported providing technology to enrollees and providers to improve access to behavioral health care during the pandemic
- As of July 2022, states have been more likely to allow audio-only coverage of behavioral health services compared to other services
- Most states have reported providing audio-only coverage (at least sometimes) across service categories, with mental health and substance use disorder (SUD) services being the most frequently covered categories
- Many states have reported permanent (i.e., non-emergency) adoption of telehealth policy expansions that were initially enacted during the pandemic temporarily. This highlights the importance of telehealth for Medicaid in expanding access to behavioral health services, especially for those in remote or underserved areas.
The KFF researchers offered this statement: “State strategies to address the behavioral health workforce shortage fall into four key areas: increasing rates, reducing burden, extending workforce, and incentivizing participation.”
These findings demonstrate the significant shift towards telehealth as a solution for providing behavioral health care during the pandemic. By expanding access to audio-only coverage and allowing for more services to be delivered via telehealth, states are making it easier for people in rural areas and older populations to access the care they need. Additionally, by expanding the types of providers that can be reimbursed for telehealth delivery, states are ensuring that a broader range of specialists is available to patients.
Monitoring Telehealth For Medicaid’s Impact On Behavioral Health Services Across States
The survey analyzed how states monitor the utilization of behavioral health telehealth, specifically through Medicaid, and the factors that states consider when assessing the impact of expanded Medicaid telehealth policy.
Key findings from the survey include:
- Nearly all states are monitoring or planning to watch the utilization of behavioral health services delivered via Medicaid Telehealth beginning in FY 2022 or 2023
- Some states expressed interest in expanding this monitoring and stratifying the use of data through additional demographic factors
- Telehealth utilization for mental health services was higher than substance use disorder (SUD) services in certain states
- Demographic utilization trends for telehealth services varied by service type and provider in some states. In New York, for example, a more significant proportion of female enrollees utilized telehealth for psychological and psychiatric services, while a higher proportion of male enrollees utilized telehealth for SUD services
- There are varying trends in how states utilize the data, with some high reporting utilization across all or most Medicaid populations and others using the data by specific subgroups.
Here are some of the key trends identified by the survey:
- Geographic: States commonly reported higher behavioral health telehealth utilization in rural areas than in urban ones
- Demographic: The survey found that behavioral health conditions are most prevalent among young adults and White people. Some states also reported that younger enrollees (including children and non-elderly adults) were most likely to utilize telehealth for behavioral health care
- Temporal: Many states reported that behavioral health telehealth use has declined from its peak earlier in the pandemic but remains high compared to pre-pandemic levels.
The survey provides valuable insight into the utilization of telehealth for Medicaid in behavioral health services and the trends shaping its impact. Healthcare professionals and policymakers may wish to consider these findings when expanding or limiting telehealth access for Medicaid enrollees.
Factors Influencing The Advancement of Telehealth For Medicaid in Behavioral Health Policy
- The use of telehealth in the Medicaid program is rising as policymakers and healthcare professionals seek to improve the quality of care for enrollees
- Analysis of data collected by the Centers for Medicare and Medicaid Services (CMS) can provide valuable insights into the impact of telehealth on the quality of care for Medicaid enrollees and inform policy decisions at the federal and state level
- The Bipartisan Safer Communities Act, signed into law in June 2022, directs CMS to provide states with options and best practices for expanding access to telehealth in Medicaid. This legislation addresses the challenges and ensures that vulnerable populations have access to the care they need
- Additionally, the Consolidated Appropriations Act passed in December 2022 authorized additional telehealth provisions, such as requirements for CMS to issue guidance on how states can use telehealth for Medicaid to deliver crisis response services. This legislation aims to help states respond to public health emergencies and provide vital services to their communities during challenging times
- Despite the progress made in recent years, there are still challenges to be addressed to realize the potential of telehealth for Medicaid fully. These include issues related to reimbursement, patient engagement, and the availability of technology and broadband infrastructure in rural and underserved areas.
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