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 similar to 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. How did the COVID-19 public health emergency impact mental health services in the Medicaid-enrolled population? This study reveals that while visits increased for adults and youth with existing mental health diagnoses, youth with new mental health needs experienced significantly lower access to specialty outpatient visits. This article explores these differences and describes the implications for the continued expansion of telehealth and the need to accommodate patients who have new mental health needs or who do not have an established provider. The COVID-19 public health emergency (PHE) generated a wide-ranging shock to the health care system and disrupted the ways in which people accessed care. This study explores how these changes affected mental health care for Medicaid-enrolled adults and youth in Washington State. Our findings show that enrollees with existing mental health conditions had better access to mental health services during the first year of the PHE, with visit rates 13% higher than before. However, youth who developed new mental health needs during the PHE faced challenges, with their access to specialty mental health services dropping by 15% in the first year and 37% in the second year. These results suggest that the COVID-19 PHE may have adversely affected access among youth with new mental health conditions. To address these potential shortcomings, efforts must extend beyond telehealth solutions to encompass a broader strategy that includes increasing provider capacity and ensuring that the initiation of care, whether in-person or remote, is welcoming and effective for new patients.