Despite Telehealth Expansion, Disparities in Availability Have Persisted

Disparities in access to mental healthcare persisted even as telehealth expanded rapidly during the COVID-19 pandemic, according to a new report released this week by the RAND Corporation.

Findings from the study were published in JAMA Network Open.

Despite the introduction of 4 state policies to spur expansion of telehealth-based services, growth of telehealth was lower among mental healthcare facilities in counties with the greatest proportion of Black residents, as well as those that accepted Medicaid or the Children’s Health Insurance Program (CHIP), a pair of government programs that primarily service lower income Americans.

“Our results show that state policies have an important role to play in expanding access to mental health, which could be lost if telehealth policies don’t stay on the books,” study lead author Ryan McBain, a policy researcher at RAND, said in a news release. “Likewise, disparities need to be addressed with local, targeted legislation.”

RAND researchers focused their efforts on the following 4 policies, all of which were found to be significantly associated with a higher likelihood that mental health treatment facilities offer telehealth services:

• Payment parity for in-person and telehealth-based services among private insurers;
• Authorization of audio-only telehealth services for Medicaid and CHIP enrollees;
• Participation in the Interstate License Exchange Program which permits psychiatrists to provide services across state lines; and
• Participation in the Psychology Interjurisdictional Compact, which enables clinical psychologists to practice across state lines.

The researchers reviewed information collected by the Mental Health and Addiction Treatment Tracking Repository for more than 12,000 facilities from April 2019 to September 2022. The study was limited to outpatient programs, which account for a large portion of telehealth-based services rendered.

During the study period, the following developments were observed:

• The percentage of mental health treatment facilities offering telehealth-based services increased from 39% to 88%.
• The number of states with payment parity legislation increased from 6 to 28.
• The number of states with audio-only payment policies increased from 0 to 33.
• The number of states allowing psychiatrists to practice across state lines increased from 28 to 38, while the states allowing clinical psychologists to practice from out-of-state increased from 7 to 32.

Despite these expansions, disparities in service availability emerged. Telehealth was more likely to be offered by facilities in rural areas and by Community Mental Health Centers. The proportion of Black residents in a county as well as the acceptance of Medicaid and CHIP were associated with a lower likelihood that a facility would offer telehealth-based treatment. Facilities in communities with more than 20% Black residents were 42% less likely to offer telehealth than those in areas with 5% or fewer Black residents. Facilities accepting Medicaid and CHIP, meanwhile, were about 25% less likely to offer telehealth options.

“While state policies appear to have aided the rapid increase in the availability of telehealth among mental health facilities, more effort is needed to address disparities to make sure all groups have equal access to care,” McBain said. 

Reference

State policies during COVID associated with increase in tele-mental health; disparities in access to care persists despite expansion, study finds. News release. RAND Corporation. June 13, 2023. Accessed June 14, 2023.