Expansion of Telehealth for Mental Health Care After State Policy Changes

Policy Associations With Telehealth Availability, all 4 state policies were associated with significantly increased odds of a mental health treatment facility offering telehealth services based on multivariable regression analyses adjusted for facility-level and county-level characteristics. Facilities in states that required payment parity for telehealth services had 11% higher odds of offering telehealth services .

Across all 4 regression models, facility-level and county-level characteristics exhibited consistent associations with telehealth availability. Specifically, mental health treatment facilities that accepted Medicaid had significantly lower odds of offering telehealth services compared with facilities that did not accept Medicaid , and CMHCs were significantly more likely to offer telehealth services than other facility types .

The percentage of Black residents in the county was inversely associated with telehealth availability. Compared with counties with 5% or fewer Black residents, counties with more than 20% Black residents had 42% lower odds of offering telehealth services . In contrast, the proportions of county residents who identified as Hispanic individuals, were aged 0 to 17 years, or were 65 years or older were not associated with the odds of a facility offering telehealth services.

In the second set of interaction models between policies of interest and county-level characteristics, we found that for 3 of 4 policies , policy implementation was associated with greater expansion of telehealth availability in urban vs rural counties . Similarly, payment parity and audio-only authorization policies were associated with greater expansion of telehealth availability in counties with a higher proportion of Black residents.

Medicaid and CHIP reimbursement for audio-only telehealth services was associated with a 73% higher likelihood of telehealth availability. This result is notable for 2 reasons. First, apart from Medicare, Medicaid is the largest insurer in the US, with more than 90 million enrollees as of 2021.

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