Telebehavioral Health (TBH) Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies

This study examined associations between state Medicaid telehealth policies and telebehavioral health (TBH) use among rural fee-for-service (FFS) beneficiaries with behavioral health needs and assessed relationships between beneficiary characteristics and TBH use. Data sources included the 2011 Medicaid Analytic eXtract, the Area Health Resources File, and a 2011 survey on state-level Medicaid telehealth policies. Specific policies studied included telehealth-specific informed consent requirements and facility fee payments to sites hosting TBH users. Participants included 70,459 rural FFS Medicaid beneficiaries who used outpatient behavioral health services; lived within 36 states whose Medicaid programs provided telehealth reimbursement in 2011; and who were not dually eligible for Medicare and Medicaid. Generalized estimating equations were used to examine how odds of TBH use were related to informed consent, facility fees, and the interaction between these variables after adjusting for covariates. Contrast analyses were performed to further specify the nature of the interaction. Although the overall prevalence of TBH use in the study sample was low (2.1%), TBH use was highest among beneficiaries with severe mental illness (3.2%), and those living in rural nonadjacent counties (2.6%) or in mental health professional shortage areas (2.2%). Where informed consent rules were present, the odds of TBH use were 327% greater among users in states that also had facility fees than for those in states without such fees (p < .0001). In the FFS Medicaid environment, engaging patients through informed consent within provider settings that receive facility fees may facilitate access to TBH services. Public Health Significance Statement Using administrative claims data reflecting fee-for-service (FFS) Medicaid environments across multiple states, this study serves as an important reference for researchers and policymakers interested in understanding what policy levers support sustained use of telehealth services. Among rural Medicaid FFS beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.