The Impact of the Medicaid Expansion on Telemental Health Utilization in Four Midwestern States

Low-income populations experience many barriers to accessing affordable, high-quality mental health services. One promising approach to improving access to care may be utilizing telemedicine in combination with expanding state Medicaid programs to cover low-income childless adults. This combination has the potential to reduce the prevalence of untreated mental illness; improve low-income populations' health and well-being; and save individuals', health care centers', and federal and state governments' money. A secondary data analysis on state Medicaid claims data was performed to calculate the percent difference in telemental health claims from 2014 through 2017 between two Medicaid expansion and two nonexpansion states in the Midwest. The percent change in claims during this time period within each of the four states was also calculated. Lastly, the difference between Medicaid telemental health utilization and other types of Medicaid telemedicine utilization was examined. The Medicaid expansion states (Iowa and Minnesota) had 54% more telemental health claims per 10,000 state population than nonexpansion states (Nebraska and Wisconsin) from 2014 through 2017. During this time period, Iowa, Minnesota, and Nebraska experienced 481%, 329%, and 12% increases in Medicaid telemental health claims, respectively, and Wisconsin experienced a 10% decrease. Medicaid telemental health utilization has been increasing since 2014 in the two Medicaid expansion states, especially in Iowa, while utilization has remained relatively constant in the two Medicaid nonexpansion states. This has implications for informing Medicaid policies, particularly with regard to Medicaid expansion and telemedicine reimbursement.