Responding to Mental Health Care Needs: Outcomes of a Telehealth Services Expansion in a Rural State
Abstract
Background: One in five adults in the U.S. is living with a mental illness (MI) (Substance Abuse and Mental Health Services Administration, 2024). Among Medicaid beneficiaries (MB), this prevalence is estimated to be 48% (Adelmann, 2003). MB with MI often have challenges in accessing available mental health treatment (Fry et al., 2021; McConnell et al., 2020). However, telehealth has become a responsive modality to enhance mental healthcare by improving access and reducing barriers (Guth, 2023; Mulvaney-Day, Dean, Miller, & Camacho-Cook, 2022).
Purpose: The purpose of this study was to examine the changes in the use of telehealth services among MB with MI in response to an expansion of these services in a rural Southeastern U.S State.
Methods: This retrospective analysis is based on Kentucky State Medicaid claims dataset from January 2018 to December 2022, inclusive of MB with MI (N=174,354). Variables obtained from the data set included age, gender, ethnicity/race, residence, MI diagnosis, payor type, and telehealth use codes. A chi-square analysis was used to examine differences in the telehealth use by year. A logistic regression analysis was used to examine factors associated with telehealth use from among key variables.
Results: The proportion telehealth use increased by year from 0.34% in 2018 to 0.99% in 2022 (Chi-square=251.5 [DF=4], p<.001). In the logistic regression analysis, those with any telehealth service codes were significantly more likely to be of younger age, female, and urban residence, and having a serious MI or a serious MI and substance use disorder (compared to a MI only), and having a fee for service payor type (compared to both managed care organization and Fee for service). There was a significant, nearly 200% increase in telehealth use by 2022 (compared to 2018).
Discussion: Despite increases in the use of telehealth services over the 5 year-period, the low rate of codified use suggests an opportunity to improve the availability of telehealth services for MB with MI in a rural southeastern state. Nurse administrators/leaders advocating for these services can consider better responsiveness to MB's in rural areas, males, and among those with substance use disorders. Given the current findings, there is a need for further nursing-led investigations regarding the use of novel technologies that may respond to the access needs and reduce the current burden of MI in vulnerable populations globally.
Notes
References: 1. Adelmann, P. K. (2003). Mental and substance use disorders among Medicaid recipients: prevalence estimates from two national surveys. Administration and Policy in Mental Health and Mental Health Services Research, 31, 111-129.
2.Fry, C. E. (2021). Medicaid waivers and access to behavioral health services: what is known and what can be expected. Psychiatric Services, 72(11), 1350-1353.
3. Guth, M. (2023). Telehealth delivery of behavioral health care in Medicaid: Findings from a survey of state Medicaid programs. Retrieved from https://www.kff.org/mental-health/issue-brief/telehealth-delivery-of-behavioral-health-care-in-medicaid-findings-from-a-survey-of-state-medicaid-programs/
4. McConnell, K. J., Charlesworth, C. J., Zhu, J. M., Meath, T. H., George, R. M., Davis, M. M., ... & Kim, H. (2020). Access to primary, mental health, and specialty care: a comparison of Medicaid and commercially insured populations in Oregon. Journal of general internal medicine, 35, 247-254.
5. Mulvaney-Day, N., Dean Jr, D., Miller, K., & Camacho-Cook, J. (2022). Trends in use of telehealth for behavioral health care during the COVID-19 pandemic: considerations for payers and employers. In (Vol. 36, pp. 1237-1241): Sage Publications Sage CA: Los Angeles, CA
6. Substance Abuse and Mental Health Services Administration. (2024). 2023 Companion infographic report: Results from the 2021, 2022, and 2023 National Surveys on Drug Use and Health (SAMHSA Publication No. PEP24-07-020). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-2022-2023-nsduh-infographic
Sigma Membership
Delta Psi at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Health Equity, Social Determinants of Health, Policy and Advocacy, Sustainable Development Goals, Mental Health, Mental Healthcare, Telehealth, Rural Areas
Recommended Citation
Okoli, Chizimuzo T.C.; Wang, Tianyi; Seng, Sarret; Abufarsakh, Bassema; Almogheer, Zainab; Al-Kayed, Jarrah; Bhattarai, Pooja; Makowski, Andrew; and Stith, Holly, "Responding to Mental Health Care Needs: Outcomes of a Telehealth Services Expansion in a Rural State" (2025). Biennial Convention (CONV). 106.
https://www.sigmarepository.org/convention/2025/posters_2025/106
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-16
Funder(s)
The Kentucky Cabinet for Health and Family Services, Department of Medicaid Services
Responding to Mental Health Care Needs: Outcomes of a Telehealth Services Expansion in a Rural State
Indianapolis, Indiana, USA
Background: One in five adults in the U.S. is living with a mental illness (MI) (Substance Abuse and Mental Health Services Administration, 2024). Among Medicaid beneficiaries (MB), this prevalence is estimated to be 48% (Adelmann, 2003). MB with MI often have challenges in accessing available mental health treatment (Fry et al., 2021; McConnell et al., 2020). However, telehealth has become a responsive modality to enhance mental healthcare by improving access and reducing barriers (Guth, 2023; Mulvaney-Day, Dean, Miller, & Camacho-Cook, 2022).
Purpose: The purpose of this study was to examine the changes in the use of telehealth services among MB with MI in response to an expansion of these services in a rural Southeastern U.S State.
Methods: This retrospective analysis is based on Kentucky State Medicaid claims dataset from January 2018 to December 2022, inclusive of MB with MI (N=174,354). Variables obtained from the data set included age, gender, ethnicity/race, residence, MI diagnosis, payor type, and telehealth use codes. A chi-square analysis was used to examine differences in the telehealth use by year. A logistic regression analysis was used to examine factors associated with telehealth use from among key variables.
Results: The proportion telehealth use increased by year from 0.34% in 2018 to 0.99% in 2022 (Chi-square=251.5 [DF=4], p<.001). In the logistic regression analysis, those with any telehealth service codes were significantly more likely to be of younger age, female, and urban residence, and having a serious MI or a serious MI and substance use disorder (compared to a MI only), and having a fee for service payor type (compared to both managed care organization and Fee for service). There was a significant, nearly 200% increase in telehealth use by 2022 (compared to 2018).
Discussion: Despite increases in the use of telehealth services over the 5 year-period, the low rate of codified use suggests an opportunity to improve the availability of telehealth services for MB with MI in a rural southeastern state. Nurse administrators/leaders advocating for these services can consider better responsiveness to MB's in rural areas, males, and among those with substance use disorders. Given the current findings, there is a need for further nursing-led investigations regarding the use of novel technologies that may respond to the access needs and reduce the current burden of MI in vulnerable populations globally.
Description
Telehealth reflects a novel modality to support mental healthcare access for Medicaid beneficiaries (MB) with mental illnesses (MI). Few studies have examined the use of telehealth services in rural states. Our study found an underutilization of telehealth in a rural state among MB. This underutilization is more prominent in rural populations in the state. Nurses can respond to such findings by advocating for improved telehealth availability for people with MI in rural populations globally.
Research reported in this presentation was supported, in part, by the Kentucky Cabinet for Health and Family Services, Department of Medicaid Services under Agreement titled “Telemental Health expansion effect on beneficiaries.”