Due to the COVID-19 pandemic, more people are receiving behavioral health treatment through telehealth services. While using telehealth technology has made behavioral health services available to more people during the pandemic, low-income people on Medicaid experience more barriers to accessing these services as safely and easily as others.
All people are entitled to the privacy of their health care information, including behavioral health patients who would not want to reveal sensitive information. Many behavioral health services require ongoing contact with a treatment provider, such as a mental health therapist or substance use counselor. These services may also require a person to reveal personal information that they do not wish to share with others, even their closest family and friends.
It can be hard for many Medicaid beneficiaries to find a private space to access behavioral health services. Low-income people already face barriers to accessing telehealth services because their households are more likely to not have access to a reliable internet connection or a device that supports typical telehealth applications. In addition to those barriers, low-income people are also more likely to live in households that do not provide enough separate, sound-proof spaces to use audio-visual telehealth services in privacy.
Given the highly personal nature of many behavioral health services, many low-income people are hesitant to receive the treatment they need at home for fear of accidentally revealing private information to the people they live with. In addition, for people experiencing ongoing domestic or interpartner violence, having a family member or partner learn about the services they are receiving could put them at risk of violence or other types of abuse.
The federal government has encouraged states to cover Medicaid behavioral health services through telehealth during the COVID-19 pandemic. The Office for Civil Rights has stated that it will not enforce certain penalties under the Health Information Portability and Accountability Act (HIPAA) for telehealth services delivered in good faith during the pandemic. In response, many states have adopted more lenient telehealth privacy policies, at least for the duration of the pandemic, which could leave beneficiaries with less privacy protection when they receive services this way.
For these reasons, it is important that state Medicaid programs protect the rights of low-income people to voluntarily choose how behavioral health services are delivered through telehealth. Telehealth services should not be the only modality for Medicaid beneficiaries receive behavioral health care services. Medicaid programs must ensure that providers must adopt adequate social distancing and hygiene procedures to protect beneficiaries who need in-person behavioral health care.
Medicaid programs should continue to provide a variety of options for accessing behavioral health services to ensure that beneficiaries can access the services they need, including through telehealth services. One promising option is telephone crisis hotlines for people experiencing significant psychological distress: Four states, Maine, Missouri, Illinois, and Texas, have already approved the use Medicaid funding for such hotline services.
Telephone crisis hotlines provide direct support to individuals in distress by helping to decrease their feelings of hopelessness and improving their problem-solving skills. Crisis hotline services can help individuals cope with grief and loss, mental illnesses, and substance use issues. Studies show that the mental status of many callers improves during and after calls to a hotline. Other studies of crisis hotlines have shown that 24-hour crisis hotlines, combined with community treatment, can reduce community psychiatric and substance abuse health care costs.
Another way some states are expanding access is through updates allow Medicaid beneficiaries to receive the behavioral health treatment they need by audio-only or text/chat telehealth services. By calling or texting with providers, people can access behavioral health care treatment while better protecting their privacy within their homes.
Colorado’s Medicaid Program, Health First Colorado, is authorizing additional services during the COVID-19 pandemic to make the delivery of health care services safer. General telehealth services now include telephone and live chat visits without an interactive audio-video component. Patients may choose to receive telehealth services from their home or any other location of their choice. Health First Colorado’s new telephone and live chat telehealth services will help Medicaid beneficiaries to receive behavioral health treatment at home while maintaining their privacy and without putting their personal information at risk.
Similarly, in response to the pandemic, Washington’s Medicaid Program, Apple Health, has put in place temporary policies to expand covered telehealth services. Apple Health now allows services to be provided through Skype or FaceTime, audio-only telephone calls, email or texting. By covering telehealth services by email and text, Apple Health is helping Washington Medicaid beneficiaries access the behavioral health services they need while protecting their privacy and following social distancing recommendations.
As the COVID-19 pandemic continues, state Medicaid programs should cover a wider range of behavioral health care services through telehealth for beneficiaries, including audio-only and text-only services, while taking steps to ensure that these delivery models provide adequate protections for patient privacy. These, and other changes, will help reduce the barriers low-income people on Medicaid experience when seeking access to safe and essential behavioral health services they need.
About the co-author: Allison Smith is a law student and Honors Scholar at the Chicago-Kent College of Law, and is an Emily Spitzer Summer Intern for NHeLP. As a former psychiatric social worker, Allison is committed to making health care available to all Americans. She has worked with individuals with disabilities in correction facilities, emergency rooms, and guardianship offices. Her goal is to advocate for adequate and equitable health care for individuals coping with neurological and psychiatric disorders.
