(PS8-D92) Behavioral Health Telehealth Utilization Among Pediatric Medicaid Beneficiaries in North Carolina

The COVID-19 pandemic increased the use of telehealth for behavioral health (BH) services. Although telehealth can offer many benefits to pediatric patients seeking BH treatment, questions remain regarding how this service modality may have mitigated or exacerbated existing inequities in access to BH care during the pandemic. The goal of our study was to examine how the expansion of telehealth for BH services affected access to care for pediatric Medicaid beneficiaries in North Carolina (NC) and inform state-level policy regarding telehealth.

We analyzed NC Medicaid claims data among pediatric beneficiaries with a BH diagnosis, at least one BH service prior to COVID-19 (March 2019 – February 2020), and who were continuously enrolled in Medicaid (March 2019 – March 2021). Beneficiaries were categorized as telehealth users if they received at least one BH service via telehealth (video or audio-only) during COVID-19 (April 2020 – March 2021). Non-telehealth users included those who only accessed BH care in-person or those who did not access BH care during COVID-19. We used a multivariable modified Poisson regression model to calculate the adjusted relative risk (ARR) of using telehealth.

Of the 167,483 pediatric beneficiaries with a BH condition, the most common conditions were neurodevelopmental conditions (39%), ADHD (34%), anxiety and obsessive-compulsive disorders (16%), adjustment disorders (16%), and depressive disorders (13%). During COVID-19, 34% used telehealth services (n=57,427), 34% used in-person services only (n=56,186), and 32% did not use any BH services (n=53,870). Across nearly all BH service types, beneficiaries received fewer services during COVID-19 than prior to COVID-19 irrespective of whether they used telehealth, though the declines in service use were much steeper among those not accessing care via telehealth. For most of the BH service types, a higher proportion of telehealth users received these services before and during COVID-19 compared to non-telehealth users. Of note, a higher percentage of telehealth users received psychotherapy during COVID-19 compared with non-telehealth users (49% versus 13%).

We found significant differences across sociodemographic groups when examining the likelihood of using telehealth during COVID-19. Black and Hispanic beneficiaries were 8% less likely to use telehealth compared to White and non-Hispanic beneficiaries, respectively. Females were significantly more likely to convert to telehealth than males (ARR=1.07; 95% CI: (1.05, 1.08)). Beneficiaries who were eligible for Medicaid through the blind/disabled programs were 15% more likely to use telehealth compared to those eligible through the general pediatrics programs. Additionally, beneficiaries who qualified for a state-specific specialized behavioral health plan were 27% more likely to use telehealth compared to beneficiaries who were not eligible for this plan. Interestingly, no significant differences were found for rural status.

Telehealth for BH services provided an opportunity to maintain care continuity during a time when social distancing was encouraged and fewer in person visits were available. Future research should investigate the factors contributing to differences in telehealth use.