Telehealth adoption for substance use and mental health disorders in Minnesota and North Dakota: a quasi-experimental study.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid adoption of telehealth services to maintain healthcare access for treating substance use disorders (SUDs) and mental health care (MHC). However, the impacts of telehealth expansion policies adopted in 2020 on access to addiction treatment in North Dakota (ND) and Minnesota (MN) remain unclear. This study examines the impact of the COVID-19 pandemic on utilization of telehealth services for SUDs and MHC in ND and MN.

Methods: We conducted a quasi-experimental study design using Medicaid telehealth claims data from 2018 to 2022. Segmented regression analysis of interrupted time series (ITS) data was employed to assess the impact of the COVID-19 pandemic (March 2020) on telehealth service utilization.

Results: From 2018 to 2022, there were 580,186 telehealth claims for SUDs (MN: 545,676; ND: 34,510) and 3.4 million claims for MHC (MN: 3.3 million; ND: 85,391). The mean telehealth utilization rate for SUDs was 5.2 vs. 7.3 per 1,000 beneficiaries and for MHC was 12.6 vs. 45.2 per 1,000 beneficiaries in ND and MN, respectively. The pandemic led to significant increases in telehealth use: ND (SUDs: +22.7/1,000; MHC: +59.8/1,000) and MN (SUDs: +30/1,000; MHC: +185.5/1,000). ND saw smaller initial increases but more gradual declines over time (SUDs: -0.42/1,000/month; MHC: -1.03/1,000/month) compared to MN (SUDs: -0.43/1,000/month; MHC: -2.78/1,000/month).

Conclusions: The COVID-19 pandemic significantly increased Medicaid telehealth utilization for SUDs and MHC in both states. MN experienced larger initial increases with steeper declines, while ND showed more sustainable utilization trends, indicating potential for sustained improvements in access to behavioral health services.