ABSTRACT
Objective
We examined how the expansion of Medicaid audio-only coverage (MAOC) was associated with changes in mental health visit rates at Federally Qualified Health Centers (FQHCs).
Data
We used publicly available FQHC-level Uniform Data Systems (UDS) data (N = 9606 FQHC-years) from 2016 to 2022. We used information from the Center for Connected Health Policy, Casetext, National Law Review, LegiScan, and other publicly available state telehealth laws and guidelines to map MAOC and other state-level Medicaid and telehealth policy variables.
Study Design
We employed a two-way fixed effects generalized difference-in-differences (DiD) estimator, followed by the Callaway–Sant’Anna DiD estimator, to assess the effect of MAOC on mental health visit rates in FQHCs. The outcome was defined as mental health visit rates, and the key independent variable was MAOC policy implementation. Time-varying state-level covariates, including mental health provider ratio, broadband access, Medicaid and telehealth policies, as well as FQHC-level covariates including the percentage of Medicaid-insured and low-income patients served, were included in the analysis. Subgroup analyses were conducted based on FQHC characteristics including rural/urban location and the presence of telemental health services (TMHS).
Principal Findings
DiD analysis showed no significant effect of MAOC on mental health visit rates across FQHCs. However, subgroup analyses revealed that FQHCs without an existing TMHS experienced a 20.5% increase in visit rates (p < 0.05), while those with a TMHS saw a 19.73% decrease (p < 0.05).
Conclusion
Audio-only telehealth appears to serve as a substitute rather than a complementary modality for in-person or video-based mental health services in FQHCs. Providing MAOC increased mental health visit rates at FQHCs without an established telemental health service, indicating improved accessibility. Given the quality concerns surrounding audio-only telehealth, further research is needed to validate this substitution effect and assess the quality of introducing these services as an option for FQHCs.