Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals.

The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.
Competing Interests: Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials. Author McConnell reports support from multiple grants from NIH, Arnold Ventures, Commonwealth Fund, Robert Wood Johnson Foundation; contracts with states of Washington and Oregon and an honorarium from the Genesis Research Group. Author Edelstein's time was supported by a grant from the National Institute of Mental Health. Author Wolk is supported by NIH grants and reports royalties from a textbook on childhood mental health and consulting fees from Massachusetts General Hospital to support a grant application. She also reports honoraria from Rutgers University Honorarium, Elwyn, Inc, and Behavior Analysis and Therapy Partners, and Participation on an Advisory Board at Penn. Author Lindner's time was supported by grants from NIH and contracts with the states of Oregon and Washington. Author Zhu reports grants from the NIHCM Foundation, AHRQ, NIMH, APA and payment for participation on an Advisory Board (Cambia Medical Policy Physician External Advisory Panel).
(© The Author(s) 2024. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)