Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic

Alexis French, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA. alexis.french@duke.edu.
Kelley A. Jones, Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
Janet Prvu Bettger, Department of Health and Rehabilitation Sciences, Temple University, 1700 N. Broad Street, Suite 300, Philadelphia, PA, 19121, USA.
Gary R. Maslow, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
Rushina Cholera, Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
Abhigya Giri, The George Washington University Biostatistics Center, 6110 Executive Blvd, Rockville, MD, 20852, USA.
Karen Swietek, NORC at the University of Chicago, 1 Broadway, 14Th Floor, Cambridge, MA, 02142, USA.
Yolande Pokam Tchuisseu, Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA.
Samantha Repka, Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA.
Salama Freed, Health Policy and Management, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, 6th Floor, Washington, DC, 20052, USA.
Rebecca Whitaker, Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA.

Document Type

Journal Article

Publication Date

8-16-2023

Journal

Journal of racial and ethnic health disparities

DOI

10.1007/s40615-023-01730-2

Keywords

Behavioral health; COVID-19; Medicaid; Mental health; Telehealth

Abstract

OBJECTIVE: We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. DATA SOURCES AND STUDY SETTING: NC Medicaid 2019-2021 beneficiary and claims data. STUDY DESIGN: This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. DATA COLLECTION/EXTRACTION METHODS: We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. PRINCIPAL FINDINGS: Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). CONCLUSIONS: During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.

Department

Health Policy and Management

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