Audio-Only Coverage of Behavioral Health Common Across Medicaid Programs

January 16, 2023 - Most states took at least one Medicaid-related policy action to expand coverage of telebehavioral health services in response to COVID-19, most commonly expanding audio-only coverage of the services, a new report shows.

Released by Kaiser Family Foundation last week, the report examines policies and utilization trends related to telebehavioral health services covered by state Medicaid programs. Researchers surveyed state Medicaid officials as part of KFF's Behavioral Health Survey of state Medicaid programs. Officials from 44 states, including the District of Columbia, responded to the survey.

Forty states took at least one policy action to expand Medicaid coverage of behavioral healthcare provided via telehealth. Of these, 28 expanded the types of behavioral health providers eligible to provide Medicaid services via telehealth, and 39 expanded the categories of Medicaid behavioral health services eligible for telehealth delivery. All 40 allowed or expanded Medicaid coverage of audio-only behavioral health services.

As of July 2022, 44 states provided audio-only coverage of mental health and substance use disorder services, the report shows. Another three provided audio-only coverage of mental health services alone, and two did not offer audio-only coverage of either service.

These policy expansions appear popular as "many states reported permanent (i.e. non-emergency) adoption of telehealth policy expansions that were initially enacted during the pandemic on a temporary basis," the report states.

States are also tracking telebehavioral health utilization. Overall, 29 states monitored utilization in fiscal year 2022, while seven states reported plans to begin monitoring in FY 2023, according to the report.

Based on data gathered, states have gleaned some trends in telebehavioral health utilization.

For instance, states most commonly report that rural areas have higher telebehavioral health utilization as compared with urban areas. Also, numerous states reported that telehealth use was higher for mental health services than substance use disorder services. But the report notes that this was likely due to the higher prevalence of mental health conditions among Medicaid beneficiaries versus substance use disorder treatment needs.

This utilization data will help shape future policy actions relating to telebehavioral health services covered by Medicaid, according to the report.

Additionally, states are looking to the federal government for guidance on Medicaid telebehavioral health policies. The Bipartisan Safer Communities Act, enacted into law last June, mandated that the Centers for Medicare and Medicaid Services (CMS) issue guidance by the end of 2023 on best practices for expanding access to telehealth within Medicaid programs, the report states.

The Government Accountability Office (GAO) also urged CMS last April to collect and analyze data on the impact of telehealth use on Medicaid care quality.

The GAO studied Medicaid telehealth data from five states and found that 32.5 million services were delivered via telehealth between March 2020 and February 2021, up significantly from 2.1 million telehealth services provided the previous year.

The agency further reviewed federal oversight documents, interviewed state and federal Medicaid officials, and compared CMS oversight with CMS guidance on using data to identify healthcare disparities.

The GAO concluded that "it is crucial for CMS to collect and analyze information to assess telehealth's effect on the quality of care Medicaid beneficiaries receive."

Telehealth's potential to expand access to mental healthcare services has also received attention from lawmakers.

Last May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives. The draft focuses on approaches to increase access to these services, including directing Medicare and Medicaid programs to support providers using telehealth.