State Medicaid Telehealth Policies and Rates of Alcohol and Substance Use Treatment at Federally Qualified Health Centers: Does Modality Matter?

Abstract

Background:

Alcohol and substance use disorders (ASUDs) are highly prevalent in the United States and are major causes of mortality, morbidity, and individual and societal costs. Adoption of telehealth policies for ASUD treatment may support access among underserved populations, such as those who are low-income and publicly insured. This study examined associations between state-level telehealth policies allowing for audio-only and text-based communication and patient utilization of ASUD services at Federally Qualified Health Centers (FQHCs).

Methods:

Data on state-level telehealth policies were obtained from the Medicaid and Children’s Health Insurance Program Payment and Access Commission. FQHC-level data about patients’ annual use of ASUD services in 2019 and 2020 were obtained from the Bureau of Primary Health Care Uniform Data System (UDS). Differences-in-differences models were used to evaluate associations between audio-only and text-based communication policies and ASUD treatment services (i.e., number of AUD and SUD visits, number of AUD and SUD patients), controlling for FQHC-level patient demographics (i.e., age, race, ethnicity, and income).

Results:

We found a 76% relative increase in AUD visits (incidence rate ratios [IRR]: 1.76, p < 0.05) and a 92% relative increase in SUD visits (IRR: 1.92, p < 0.05) in states with Medicaid policies that enabled audio-only telehealth in 2020. We found no relative increase in the number of ASUD visits or patients in states with Medicaid policies allowing for text-based communication.

Conclusion:

State-level Medicaid policies that permit the use of audio-only telehealth for ASUD treatment may be important tools to address the needs of medically underserved populations with AUD and SUD across the United States.